Rebuilding trust in proton pump inhibitor therapy

Abstract

Introduction of proton pump inhibitor (PPI) therapy into clinical practice has revolutionized treatment approach to acid-related diseases. With its clinical success came a widespread use of PPI therapy. Subsequently, several studies found that PPIs were oftentimes overprescribed in primary care and emergency setting, likely attributed to seemingly low side-effect profile and physicians having low threshold to initiate therapy. However, now there is a growing concern over PPI side-effect profile among both patients and providers. We would like to bring more awareness to the currently available guidelines on PPI use, discuss clinical indications for PPIs and the evidence behind the reported side-effects. We hope that increased awareness of proper PPI use will make the initiation or continuation of therapy a well informed and an evidence-based decision between patient and physician. We also hope that discussing evidence behind the reported side-effect profile will help clarify the growing concerns over PPI therapy.

Keywords: Proton pump inhibitor; Side-effects; Gastro-esophageal reflux disease; Therapy

Core Tip: Proton pump inhibitor (PPI) therapy is a cornerstone therapy for acid-related diseases. Its clinical success can be attributed to anti-secretory properties superior to any prior agents and seemingly low side-effects profile. As more patients were started and continued PPI therapy long-term, some studies began reporting side-effects associated with this therapy. Concerns over risks associated with PPI use grew over the last couple of years among both patients and providers. We hope to bring awareness to the current guidelines and the evidence behind the reported side-effects as better understanding of this evidence can improve medical practice. Both patients and providers should have all the evidence at hand when discussing initiation or continuation of PPI therapy.