Over-utilization of Proton-Pump Inhibitors

Proton pump inhibitors (PPIs) are among the most commonly used medications in the world. Developed for the treatment and prevention of acid-mediated upper gastrointestinal conditions, these agents are being used increasingly for indications where their benefits are less certain and for indeterminate durations.


Long-term PPI use has been associated with several safety concerns:

  • Clostridium difficile and other enteric infections
  • Microscopic colitis
  • Hypergastrinemia
  • Atrophic gastritis
  • Intestinal colonization of multidrug resistant organisms
  • Inflammatory bowel disease
  • Malabsorption of minerals and vitamins
  • Magnesium malabsorption
  • Malabsorption of Calcium and Fracture Risk: The FDA has mandated revised safety information on all PPIs about a possible increased risk of fractures of the hip, wrist, and spine.
  • Vitamin B12 malabsorption
  • Iron malabsorption
  • Kidney disease
  • Dementia
  • Pneumonia


All patients taking a PPI should have a regular review of the ongoing indications for use and documentation of that indication. All patients without a definitive indication for chronic PPI should be considered for trial of deprescribing. If you are not sure, refer to gastroenterology (stomach doctor).


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