title: Adverse effects of long-term proton pump inhibitor therapy.
abstract: Proton pump inhibitors have an excellent safety profile and have become one of the most commonly prescribed class of drugs in primary and specialty care. Long-term, sometimes lifetime, use is becoming increasingly common, often without appropriate indications. This paper is a detailed review of the current evidence on this important topic, focusing on the potential adverse effects of long-term proton pump inhibitor use that have generated the greatest concern: B12 deficiency; iron deficiency; hypomagnesemia; increased susceptibility to pneumonia, enteric infections, and fractures; hypergastrinemia and cancer; drug interactions; and birth defects. We explain the pathophysiological mechanisms that may underlie each of these relationships, review the existing evidence, and discuss implications for clinical management. The benefits of proton pump inhibitor use outweigh its risks in most patients. Elderly, malnourished, immune-compromised, chronically ill, and osteoporotic patients theoretically could be at increased risk from long-term therapy.
authors.affiliation: Department of Medicine and Division of Gastroenterology and Hepatology, Stanford University School of Medicine, Stanford, CA 94305, USA. esheen@stanford.edu
authors.forename: Edward
authors.initials: E
authors.lastname: Sheen
authors.forename: George
authors.initials: G
authors.lastname: Triadafilopoulos
mesh_terms: D000818:Animals; D000897:Anti-Ulcer Agents / Q000009:adverse effects / Q000627:therapeutic use; D002276:Carcinoid Tumor / Q000139:chemically induced / Q000503:physiopathology; D000013:Congenital Abnormalities / Q000209:etiology / Q000503:physiopathology; D003967:Diarrhea / Q000139:chemically induced / Q000503:physiopathology; D004347:Drug Interactions; D005260:Female; D050723:Fractures, Bone / Q000139:chemically induced / Q000503:physiopathology; D006801:Humans; D000090463:Iron Deficiencies; D008274:Magnesium / Q000097:blood; D008297:Male; D011014:Pneumonia / Q000209:etiology / Q000503:physiopathology; D054328:Proton Pump Inhibitors / Q000009:adverse effects* / Q000627:therapeutic use; D051381:Rats; D013272:Stomach Diseases / Q000139:chemically induced / Q000503:physiopathology; D013274:Stomach Neoplasms / Q000139:chemically induced / Q000503:physiopathology; D016896:Treatment Outcome; D014806:Vitamin B 12 Deficiency / Q000139:chemically induced / Q000503:physiopathology
chemical_list: D000897:Anti-Ulcer Agents; D054328:Proton Pump Inhibitors; D008274:Magnesium