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The possible risks of proton pump inhibitors

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These drugs have revolutionised the management of gastrointestinal diseases, but their long term use may have risks

Proton pump inhibitors (PPIs) suppress gastric acid secretion by selectively inhibiting the enzyme hydrogen–potassium adenosine triphosphatase, located in gastric parietal cells. These drugs superseded H2-receptor antagonists as first-line acid suppressants in the 1980s, and their potent effect has revolutionised the management of common upper gastrointestinal (GI) disorders, including gastro-oesophageal reflux disease, peptic ulcer disease, and functional dyspepsia. These drugs are also widely used as part of regimens designed to eradicate Helicobacter pylori infection, and as prophylaxis against the deleterious effects of non-steroidal anti-inflammatory drugs on the GI tract.

PPIs are among the most commonly administered medications worldwide. In recent years, there has been a marked increase in prescribing PPIs,1 concurrent with an overall reduction in their cost with the advent of inexpensive generic formulations. This reduction in cost is likely to have contributed to injudicious overprescribing of PPIs, with up to 60% of primary care physicians making no attempt to reduce patients’ doses over time, and almost 50% of patients receiving long term PPI therapy having no clear indication for its continuation.2 Despite…