Proton Pump Inhibitors: Review of Emerging Concerns

Abstract

First introduced in 1989, proton pump inhibitors (PPIs) are among the most widely utilized medications worldwide, both in the ambulatory and inpatient clinical settings. The PPIs are currently approved by the US Food and Drug Administration for the management of a variety of gastrointestinal disorders including symptomatic peptic ulcer disease, gastroesophageal reflux disease, and nonulcer dyspepsia as well as for prevention of gastrointestinal bleeding in patients receiving antiplatelet therapy. PPIs inhibit gastric acid secretion, and the most commonly associated adverse effects include abdominal pain, diarrhea, and headache. Although PPIs have had an encouraging safety profile, recent studies regarding the long-term use of PPI medications have noted potential adverse effects, including risk of fractures, pneumonia, Clostridium difficile diarrhea, hypomagnesemia, vitamin B deficiency, chronic kidney disease, and dementia. These emerging data have led to subsequent investigations to assess these potential risks in patients receiving long-term PPI therapy. However, most of the published evidence is inadequate to establish a definite association between PPI use and the risk for development of serious adverse effects. Hence, when clinically indicated, PPIs can be prescribed at the lowest effective dose for symptom control.

Low gut microbiota diversity and dietary magnesium intake are associated with the development of PPI‐induced hypomagnesemia

“…Proton pump inhibitors (PPIs) are the first-line treatment of acid-related gastric diseases and are among the most widely prescribed drugs in the world, accounting for more than 7 billion euros in expenditures annually (1). Supported by their presumed excellent safety profile, the number of PPI users is still steadily increasing, despite concerns of overprescription and inappropriate usage (2,3). Recently, long-term PPI intake has been associated with serious adverse effects including gastrointestinal complaints, enteric infections, and respiratory infections (4).…”

Proton pump inhibitors and risk of gastric cancer in a case–control study

“…Proton pump inhibitors are widely used for the management of peptic ulcer disease, gastroesophageal reflux disease and eradication of Helicobacter pylori infection 5. However, its safety for long-term use has raised pubic concern 6. In order to clarify the relationship between proton pump inhibitors use and gastric cancer, we used the 2000–2013 database of Taiwan National Health Insurance Program to conduct a population-based case–control study.…”

Ginseng Ameliorates Effect of Prolonged Use of Omeprazole in Rat Renal Cortex through Decreasing Inflammation, Fibrosis and Apoptosis

“…The proton pump inhibitors (PPIs) are group of drugs that widely used to suppress gastric acid production by inhibiting functions of the H+/K+ ATPase pump in gastric mucosal parietal cells (Al-Qaisi et al, 2018) . Omeprazole, the prodrug of this family, is considered the first choice for most, if not all, acid related gastrointestinal disorders (Nehra et al, 2018) . It thought to has a good safety profile with a little frequency of adverse effects as nausea, diarrhea, headache and abdominal pain (Al-Qaisi et al, 2018) but it have been increasingly suspected of causing renal disorders particularly among older patients (Fatima et al, 2019) or even adolescents (Noone et al, 2014) .…”