Unexpected consequences of proton pump inhibitor use.

Proton pump inhibitors (PPIs) are among the most widely prescribed classes of medications for gastroesophageal and laryngopharyngeal reflux diseases. There is emerging evidence that the pathogenesis of disease in laryngeal mucosa is not just related to refluxed acid, but also the presence of pepsin and acidic microenvironments. The widespread use of PPIs is also calling into question potential complications of PPI use. This commentary expands upon these issues with other potential unexpected consequences, and considers the importance of determining a proper approach to patient management.