Risks of proton-pump inhibitors: what every doctor should know

Talley, Nicholas J

doi:10.5694/j.1326-5377.2009.tb02305.x

Topics

No drug is completely safe and, while the risks seem small, some side effects can be serious

When I went to medical school, the mantra “know thy drugs” was pounded into me repeatedly, and it has served me well. Among the most commonly prescribed drugs in Australia are the proton-pump inhibitors (PPIs). In 2005, one million Australians were dispensed drugs in this class.1 There is no doubt that PPIs are safe relative to most other medications we prescribe, but suppressing gastric acid is not physiological.2

Mayo Clinic, Jacksonville, Fla, USA.

Correspondence: talley.nicholas@mayo.edu

Competing interests:

I have received research support from Takeda Pharmaceutical Company Ltd and have acted as a consultant to AstraZeneca, GlaxoSmithKline and Wyeth.

1. Roughead EE, Ramsay EN, Pratt NL, et al. Proton-pump inhibitors and the risk of antibiotic use and hospitalisation for pneumonia. Med J Aust 2009; 190: 114-116. <MJA full text>
2. Moayyedi P, Talley NJ. Gastro-oesophageal reflux disease. Lancet 2006; 367: 2086-2100.
3. Laheij RJ, Sturkenboom MC, Hassing RJ, et al. Risk of community-acquired pneumonia and use of gastric acid-suppressive drugs. JAMA 2004; 292: 1955-1960.
4. Gulmez SE, Holm A, Frederiksen H, et al. Use of proton pump inhibitors and the risk of community-acquired pneumonia: a population-based case-control study. Arch Intern Med 2007; 167: 950-955.
5. Dial S, Delaney JA, Barkun AN, Suissa S. Use of gastric acid-suppressive agents and the risk of community-acquired Clostridium difficile-associated disease. JAMA 2005; 294: 2989-2995.
6. Leonard J, Marshall JK, Moayyedi P. Systematic review of the risk of enteric infection in patients taking acid suppression. Am J Gastroenterol 2007; 102: 2047-2056.
7. Yang YX, Lewis JD, Epstein S, Metz DC. Long-term proton pump inhibitor therapy and risk of hip fracture JAMA 2006; 296: 2947-2953.
8. Targownik LE, Lix LM, Metge CJ, et al. Use of proton pump inhibitors and risk of osteoporosis-related fractures. CMAJ 2008; 179: 319-326.
9. Talley NJ, Jung HK, Jiang X, Locke GR. Is there an increased risk of hip fracture in patients on long-term PPI therapy? Nat Clin Pract Gastroenterol Hepatol 2007; 4: 420-421.
10. Epstein M, McGrath S, Law F. Proton-pump inhibitors and hypomagnesemic hypoparathyroidism. N Engl J Med 2006; 355: 1834-1836.
11. Marcuard SP, Albernaz L, Khazanie PG. Omeprazole therapy causes malabsorption of cyanocobalamin (vitamin B12). Ann Intern Med 1994; 120: 211-215.
12. Kuipers EJ, Lundell L, Klinkenberg-Knol EC, et al. Atrophic gastritis and Helicobacter pylori infection in patients with reflux esophagitis treated with omeprazole or fundoplication. N Engl J Med 1996; 334: 1018-1022.
13. Klinkenberg-Knol EC, Nelis F, Dent J, et al. Long-term omeprazole treatment in resistant gastroesophageal reflux disease: efficacy, safety, and influence on gastric mucosa. Gastroenterology 2000; 118: 661-669.
14. Malfertheiner P, Megraud F, O’Morain C, et al. Current concepts in the management of Helicobacter pylori infection: the Maastricht III Concensus Report. Gut 2007; 56: 772-781.
15. Yang YX, Hennessy S, Propert K, et al. Chronic proton pump inhibitor therapy and the risk of colorectal cancer Gastroenterology 2007; 133: 748-754.
16. Brewster UC, Perazella MA. Proton pump inhibitors and the kidney: critical review. Clin Nephrol 2007; 68: 65-72.

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