Proton pump inhibitors (PPI) are often self-prescribed by the patients and since PPIs are available over-the-counter, patients can have free access to them and for long periods of time, without seeking medical attention. Although guidelines for OTC use suggest a short course (2 week treatment) of PPIs in patients with typical complaints (acid and/or regurgitation), and without alarm symptoms, great potential for misuse and/or overuse does exist. PPIs as a class end in the suffix, “prazole”, e.g. pantoprazole, omeprazole, lansoprazole, esomeprazole, etc.
Potential complications of chronic PPI use
| Potential adverse effect | Plausible underlying biological mechanism |
| Risk of fracture | Reduced calcium absorption in the duodenum and proximal jejunum as a consequence of achloridria |
| Hypomagnesaemia | Poorly defined (gastrointestinal malabsorption and renal wasting) |
| Vitamin B12 deficiency | Reduced acid-activated proteolytic digestion in the stomach related to reduced absorption |
| Dementia | High levels of amyloid-β and deposition of amyloid-β peptides in brains of animal models |
| Cardiovascular risk | Competitive metabolism effect on cytochrome P450 |
| Renal disease | Unclear (deposit of PPIs or their metabolites in the kidney’s tubulo-interstitium stimulating immune response) |
| C. difficile infection | Reduce gastric acidity may promote bacterial colonization in the GI tract |
| Pneumonia | Potential micro-aspiration or translocation into the lungs from upper GI bacterial overgrowth |
| Fundic gland polyps | Trophic effect of high gastrin levels on GI mucosa |
| Gastric cancer | Possible synergic effect of PPI treatment and Helicobacter pylori infection |
| Colon cancer | Trophic effect of high gastrin levels on colon cancer cells in vitro |
Further reading:
, , , , , , and (2017) Proton pump inhibitors: Risks of long-term use. Journal of Gastroenterology and Hepatology, 32: 1295–1302. doi: 10.1111/jgh.13737.