PPIs and Safety Concerns - A Pending Verdict?

Proton pump inhibitors (PPIs) with a high therapeutic index have strong evidence to support their efficacy in the management of common gastrointestinal (GI) conditions such as gastroesophageal reflux (GERD), peptic ulcer diseases, H. pyloriinfection etc. Despite this, the list of adverse effects being cited across literature with chronic use of these drugs is on an upward trend. Studies and published literature have associated PPI use with risk of bone fractures, various micronutrient deficiencies, gastro-intestinal infection, pneumonia, cardiac complications, dementia, kidney disease, intestinal bacterial overgrowth and drug interactions. It is however of clinical interest to note that in most of the studies published, the risk association reported with PPIs is weak. Unfortunately, widespread media publicity around these studies has prompted discontinuation of the drug in patients in whom it is indicated and created generalized anxiety among its users 20 years later since their introduction. The primary objective is to review the literature for an unbiased translation of the knowledge to appropriately guide decision in clinical practice.