title: [Emergent adverse effects of proton pump inhibitors].
abstract: BACKGROUND
  Recent literature reports of potential adverse effects (AEs) of proton pump inhibitors (PPIs), especially during long-term treatments.
  
  
  OBJECTIVE
  To present a literature review of major AEs: digestive infections, pneumonia, bone fracture, hypomagnesemia, interstitial nephritis, gastric cancer and neutropenia.
  
  
  METHODS
  The authors used Pubmed; articles in English or French, published between August 2006 and August 2011 were analyzed.
  
  
  METHODS
  Two reviewers analyzed the references of title and summary to retain mainly observational studies, controlled clinical trials, meta-analyzes, case reports.
  
  
  RESULTS
  For digestive infections: observational studies have shown a link moderate to high (OR 1.4 to 8.3) with exposure to PPIs. For pneumonia: some case-control studies reported a modest significative risk (OR 1.2 to 1.6), some not. The risk appears dose dependent and greater in subjects at risk. For fractures: the majority of observational studies report a significative increase in low to moderate risk (OR 1.2 to 3.1), correlated with the dose and duration of treatment. For magnesium deficiency: rare but potentially severe, they are described in case reports. Interstitial nephritis are described in case reports and for different PPIs, suggesting a class effect. For the stomach neoplasm: if three observational studies show an increased cancer risk (OR 1.5 to 2, 3), confounding factors make the causal link uncertain. Neutropenia is reported in a clinical observation, a class effect is suggested.
  
  
  CONCLUSIONS
  One can regret the absence of controlled clinical trials; indeed the observational studies have the interest to move closer to "real life", but often have methodological bias.
  
  
  CONCLUSIONS
  Although AEs PPIs do not call into question the usefulness of this drug class, they show the need to limit their prescribing to indications for which efficacy has been proven. Moreover, PPIs treatment must be regularly reassessed to avoid exposing patients to unnecessary risks.
authors.affiliation: Groupement Hospitalier Sud, Hospices Civils de Lyon, Hôpital Henry Gabrielle, Département de Pharmacie Clinique, 69230 St Genis Laval, France.
authors.forename: Cindy
authors.initials: C
authors.lastname: Bourne
authors.forename: Bruno
authors.initials: B
authors.lastname: Charpiat
authors.forename: Nicolas
authors.initials: N
authors.lastname: Charhon
authors.forename: Camille
authors.initials: C
authors.lastname: Bertin
authors.forename: Aurore
authors.initials: A
authors.lastname: Gouraud
authors.forename: Christelle
authors.initials: C
authors.lastname: Mouchoux
authors.forename: Saadia
authors.initials: S
authors.lastname: Skalli
authors.forename: Audrey
authors.initials: A
authors.lastname: Janoly-Dumenil
mesh_terms: D000465:Algorithms; D016360:Clostridioides difficile / Q000472:pathogenicity; D064420:Drug-Related Side Effects and Adverse Reactions / Q000453:epidemiology*; D004761:Enterocolitis, Pseudomembranous / Q000139:chemically induced / Q000453:epidemiology / Q000209:etiology; D050723:Fractures, Bone / Q000139:chemically induced / Q000453:epidemiology / Q000209:etiology; D006801:Humans; D053565:Hypercalciuria / Q000139:chemically induced / Q000453:epidemiology / Q000209:etiology; D015994:Incidence; D008171:Lung Diseases / Q000139:chemically induced / Q000453:epidemiology / Q000209:etiology; D009369:Neoplasms / Q000139:chemically induced / Q000453:epidemiology / Q000209:etiology; D009397:Nephrocalcinosis / Q000139:chemically induced / Q000453:epidemiology / Q000209:etiology; D054328:Proton Pump Inhibitors / Q000009:adverse effects*; D015499:Renal Tubular Transport, Inborn Errors / Q000139:chemically induced / Q000453:epidemiology / Q000209:etiology; D012307:Risk Factors
chemical_list: D054328:Proton Pump Inhibitors