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Review
. 2018 Apr 30;24(2):182-196.
doi: 10.5056/jnm18001.

Advantages and Disadvantages of Long-term Proton Pump Inhibitor Use

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Free PMC article
Review

Advantages and Disadvantages of Long-term Proton Pump Inhibitor Use

Yoshikazu Kinoshita et al. J Neurogastroenterol Motil. .
Free PMC article

Abstract

Proton pump inhibitors (PPIs) potently inhibit gastric acid secretion and are widely used for treatment of acid-related diseases including gastroesophageal reflux disease and secondary prevention of aspirin/NSAID-induced ulcers. Although clinically important adverse effects of PPIs can occur, just as with other drugs, those are not frequently observed during or after administration. Thus, PPIs are regarded as relatively safe and considered to be clinically beneficial. Recently, PPIs have become frequently administered to patients with functional gastrointestinal diseases or primary prevention of drug-related gastroduodenal damage, even though their beneficial effects for those conditions have not been fully confirmed. PPIs tend to be given for conditions in which the necessity of the drug has not been clarified, thus otherwise rare adverse effects are presented as clinically relevant. Although several PPI-related adverse effects have been reported, their clinical relevance is not yet clear, since the evidence reported in those studies is not at a high enough level, as the majority are based on retrospective observational studies and the reported hazard ratios are low. It is important to administer PPIs only for patients who will gain a substantial clinical benefit and to continue to investigate their adverse effects with high quality prospective studies.

Keywords: Adverse effect; Allergic disease; Gastric acid; Gastroesophageal reflux; Ulcer.

Conflict of interest statement

Conflicts of interest: Outside of this article, Yoshikazu Kinoshita received honoraria from Eisai pharmaceutical Co, EA pharma, Zeria pharmaceutical Co, Astellas pharma, AstraZeneca KK, Takeda pharma, Daiichi-Sankyo pharma, Abbott Japan, Otsuka pharma, Sucampo pharma, Mylan, Sato pharma, Ono pharma, Taisho-Toyama pharma, Sumitomo-Dainippon pharma, and Mochida pharma.

Figures

Figure 1
Figure 1
Acid-inhibition unrelated adverse events reported during proton pump inhibitor administration. Possible evidence level and effect size of each adverse effect is shown.
Figure 2
Figure 2
Acid-inhibition related adverse events reported during proton pump inhibitor administration. Possible evidence level and effect size of each adverse effect is shown. SIBO, small intestinal bacterial overgrowth; SBP, spontaneous bacterial peritonitis.
Figure 3
Figure 3
Beneficial effects and possible adverse effects need to be balanced, when proton pump inhibitors (PPIs) are administered as many other drugs. Beneficial effects of PPIs for the long-term treatment of gastroesophageal reflux disease (GERD) and prevention of aspirin/non-steroidal anti-inflammatory drug (NSAID)-induced ulcers are strong enough when PPIs are administered only to appropriate patients. PPIs also have several acid-inhibition related and unrelated adverse effects although the clinical impacts of these adverse events are not so serious. However, balancing beneficial and adverse effects as well as selecting appropriate patients who will get larger benefits by the PPIs administration are critically important. SIBO, small intestinal bacterial overgrowth.

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