title: The risks of PPI therapy.
abstract: PPIs have become one of the most commonly used medications worldwide, as they are the treatment of choice for several acid-related gastrointestinal disorders. However, concerns have been raised about PPI therapy, including the risk of pneumonia, bone fractures and enteric infections, and a possible interaction with clopidogrel that could increase the risk of cardiovascular events. Observational studies have shown very modest associations between PPI therapy and these risks, although the association between PPI treatment and the risk of enteric infections seems to be stronger than the association with other risk factors. However, given the inherent limitations of observational studies, these associations could be attributable to bias and/or confounding factors. In addition, evidence from randomized, controlled trials does not support a clinically significant effect of PPI therapy on the risk of cardiovascular events in patients taking clopidogrel or the risk of pneumonia. Nevertheless, it is impossible to exclude the possibility that some of these associations might be causal or indeed that PPI therapy has an as yet unknown long-term adverse effect. As with any therapy, therefore, it is advisable to prescribe PPIs only to patients for whom these drugs have been proven beneficial.
authors.affiliation: Division of Gastroenterology, Department of Medicine, McMaster University, 1280 Main Street West, HSC Room 4W8E, Hamilton, ON L8S 4K1, Canada. moayyep@mcmaster.ca
authors.forename: Paul
authors.initials: P
authors.lastname: Moayyedi
authors.forename: Grigorios I
authors.initials: GI
authors.lastname: Leontiadis
mesh_terms: D050723:Fractures, Bone / Q000453:epidemiology*; D005767:Gastrointestinal Diseases / Q000188:drug therapy* / Q000453:epidemiology*; D006801:Humans; D009894:Opportunistic Infections / Q000453:epidemiology*; D011014:Pneumonia / Q000453:epidemiology*; D054328:Proton Pump Inhibitors / Q000008:administration & dosage / Q000009:adverse effects*; D012307:Risk Factors
chemical_list: D054328:Proton Pump Inhibitors