Both patients and physicians have a lot of questions about the safety of proton pump inhibitors (PPIs), a class of medications that have been a mainstay in the management of acid reflux disease (GERD) over the last 25 years. There have been reports in the media associating long-term PPIs with a number of problems. Given many patients have been on these medications for management of their GERD for year, they wonder if it is safe to continue on these medications long-term. Often they have tried to discontinue the medication but found alternative medication not as effective in controlling symptoms.
To help address these concerns, a panel of gastroenterology experts recently published a review of the literature and proposed best practice advice about their use. They looked carefully at the all the available studies that have been published that have associated long-term PPI use with complications. The list of problems attributed to PPI use have included dementia, osteoporosis, pneumonia, kidney disease, heart disease, GI infections and micronutrient deficiencies among others. After analyzing the medical data, these GI experts concluded “Despite the long list of potential adverse effects associated with PPI therapy, the quality of the evidence underlying these associations is consistently low to very low. The benefits of PPIs likely outweigh the risks as long as they are prescribed appropriately.”
Here are some of the best practice guidelines that the expert panel felt may be helpful in the use of PPIs. These are sensible recommendations that are based on the best evidence about the risks and benefits of a class of widely prescribed medications.
as NSAIDS may require long-term PPI use.
routinely require monitoring of calcium, magnesium, creatinine or bone mineral
Reference: Freedberg et al. Gastroenterology 2017; 152:706