title: Proton-pump inhibitors adverse effects: a review of the evidence and position statement by the Sociedad Española de Patología Digestiva.
abstract: BACKGROUND
  In the last few years a significant number of papers have related the use of proton-pump inhibitors (PPIs) to potential serious adverse effects that have resulted in social unrest.
  
  
  OBJECTIVE
  The goal of this paper was to provide a literature review for the development of an institutional position statement by Sociedad Española de Patología Digestiva (SEPD) regarding the safety of long-term PPI use.
  
  
  METHODS
  A comprehensive review of the literature was performed to draw conclusions based on a critical assessment of the following: a) current PPI indications; b) vitamin B12 deficiency and neurological disorders; c) magnesium deficiency; d) bone fractures; e) enteric infection and pneumonia; f) interactions with thienopyridine derivatives; e) complications in cirrhotic patients.
  
  
  RESULTS
  Current PPI indications have remained unchanged for years now, and are well established. A general screening of vitamin B12 levels is not recommended for all patients on a PPI; however, it does seem necessary that magnesium levels be measured at therapy onset, and then monitored in subjects on other drugs that may induce hypomagnesemia. A higher risk for bone fractures is present, even though causality cannot be concluded for this association. The association between PPIs and infection with Clostridium difficile is mild to moderate, and the risk for pneumonia is low. In patients with cardiovascular risk receiving thienopyridines derivatives it is prudent to adequately consider gastrointestinal and cardiovascular risks, given the absence of definitive evidence regardin potential drug-drug interactions; if gastrointestinal risk is found to be moderate or high, effective prevention should be in place with a PPI. PPIs should be cautiously indicated in patients with decompensated cirrhosis.
  
  
  CONCLUSIONS
  PPIs are safe drugs whose benefits outweigh their potential side effects both short-term and long-term, provided their indication, dosage, and duration are appropriate.
authors.affiliation: Sección de Aparato Digestivo. , Hospital de Cabueñes, España.
authors.forename: Cristóbal
authors.initials: C
authors.lastname: de la Coba Ortiz
authors.affiliation: UGC Aparato Digestivo, H. Universitario Virgen Macarena, España.
authors.forename: Federico
authors.initials: F
authors.lastname: Argüelles Arias
authors.affiliation: Gastroenterología y Hepatología, Hospital Universitario Ramón y Cajal, España.
authors.forename: Carlos
authors.initials: C
authors.lastname: Martín de Argila de Prados
authors.affiliation: Departamento de Gestión del Conocimiento, Sociedad Española de Patología Digestiva SEPD, España.
authors.forename: Javier
authors.initials: J
authors.lastname: Júdez Gutiérrez
authors.affiliation: Servicio Aparato Digestivo, Sanatorio Nuestra Señora de Covadonga, España.
authors.forename: Antonio
authors.initials: A
authors.lastname: Linares Rodríguez
authors.affiliation: UGC Enfermedades Digestivas, Instituto de Investigación Biomédica de Málaga (IBIMA), Hospital Universitario Virgen de la Victoria, España.
authors.forename: Aida
authors.initials: A
authors.lastname: Ortega Alonso
authors.affiliation: Gastroenterología y Hepatología, Hospital Universitario Ramón y Cajal, España.
authors.forename: Enrique
authors.initials: E
authors.lastname: Rodríguez de Santiago
authors.affiliation: UGC Intercentros de Aparato Digestivo , Hospital Universitario Virgen de la Macarena (HUVM), España.
authors.forename: Manuel
authors.initials: M
authors.lastname: Rodríguez-Téllez
authors.affiliation: Servicio Aparato Digestivo, Hospital Universitario Puerta de Hierro Majadahonda, ESPAÑA.
authors.forename: María Isabel
authors.initials: MI
authors.lastname: Vera Mendoza
authors.affiliation: Gastroenterología y Hepatología, Hospital Universitario Ramón y Cajal. , España.
authors.forename: Lara
authors.initials: L
authors.lastname: Aguilera Castro
authors.affiliation: Servicio de Aparato Digestivo, Hospital Clínico San Carlos. Universidad Complutense de Madrid., España.
authors.forename: Ángel
authors.initials: Á
authors.lastname: Álvarez Sánchez
authors.affiliation: Unidad de Gestión Clinica de Aparato Digestivo, Instituto de Investigación Biomédica de Málaga (IBIMA), Hospital Universitario Virgen de la Victoria, España.
authors.forename: Raúl Jesús
authors.initials: RJ
authors.lastname: Andrade Bellido
authors.affiliation: Sección Aparato Digestivo, Hospital San Eloy, España.
authors.forename: Fidencio
authors.initials: F
authors.lastname: Bao Pérez
authors.affiliation: Servicio de Aparato Digestivo, Hospital Universitario de Valme, España.
authors.forename: Manuel
authors.initials: M
authors.lastname: Castro Fernández
authors.affiliation: Servicio de Aparato Digestivo, Hospital Universitario Central de Asturias, España.
authors.forename: Froilán
authors.initials: F
authors.lastname: Giganto Tomé
mesh_terms: D004347:Drug Interactions; D019317:Evidence-Based Medicine; D050723:Fractures, Bone / Q000453:epidemiology / Q000209:etiology; D006801:Humans; D007239:Infections / Q000453:epidemiology; D008103:Liver Cirrhosis / Q000150:complications; D008275:Magnesium Deficiency / Q000139:chemically induced / Q000453:epidemiology; D009422:Nervous System Diseases / Q000139:chemically induced / Q000453:epidemiology; D054328:Proton Pump Inhibitors / Q000008:administration & dosage / Q000009:adverse effects* / Q000627:therapeutic use
chemical_list: D054328:Proton Pump Inhibitors