title: The Indications, Applications, and Risks of Proton Pump Inhibitors.
abstract: BACKGROUND
  Proton pump inhibitors (PPI) are the most effective drugs for inhibiting gastric acid secretion. They have been in clinical use for more than 25 years, In 2014, 3.475 billion daily defined doses (DDD) of PPI were prescribed in Germany. This high number alone calls for a critical analysis of the spectrum of indications for PPI and their potential adverse effects.
  
  
  METHODS
  This review is based on pertinent publications retrieved by a selective search in the PubMed and Cochrane Library databases, with particular emphasis on randomized, prospective multicenter trials, cohort studies, case-control studies, and meta-analyses.
  
  
  RESULTS
  The inhibition of gastric acid secretion with PPI is successfully used for the treatment of gastroesophageal reflux disease and of gastric and duodenal ulcers, for the secondary prevention of gastroduodenal lesions that have arisen under treatment with nonsteroidal anti-inflammatory drugs and acetylsalicylic acid, and for the prevention of recurrent hemorrhage from ulcers after successful endoscopic hemostasis. PPI are given along with practically all antibiotic regimens for the eradication of Helicobacter pylori infection. The number of prescriptions for PPI has risen linearly over the past 25 years. As there has been no broadening of indications, one may well ask whether the current, extensive use of PPI is justified. There is evidence that patients taking PPI are at greater risk for fractures. Moreover, the vitamin B12 level should be checked occasionally in all patients taking PPI.
  
  
  CONCLUSIONS
  PPI are among the more effective drugs for the treatment of diseases associated with gastric acid. In view of their cost and potential adverse effects, they should only be prescribed for scientifically validated indications.
authors.affiliation: Division of Gastroenterology and Rheumatology, Department of Internal Medicine, Neurology and Dermatology, University Hospital of Leipzig, Germany.
authors.forename: Joachim
authors.initials: J
authors.lastname: Mössner
mesh_terms: D004305:Dose-Response Relationship, Drug; D004334:Drug Administration Schedule; D019317:Evidence-Based Medicine; D050723:Fractures, Bone / Q000139:chemically induced* / Q000517:prevention & control; D005764:Gastroesophageal Reflux / Q000188:drug therapy / Q000517:prevention & control*; D005765:Gastrointestinal Agents / Q000008:administration & dosage; D006801:Humans; D010437:Peptic Ulcer / Q000188:drug therapy / Q000517:prevention & control*; D054328:Proton Pump Inhibitors / Q000008:administration & dosage* / Q000009:adverse effects*; D016896:Treatment Outcome; D014806:Vitamin B 12 Deficiency / Q000139:chemically induced* / Q000517:prevention & control
chemical_list: D005765:Gastrointestinal Agents; D054328:Proton Pump Inhibitors