Proton pump inhibitors: use, misuse and concerns about long-term therapy

Proton pump inhibitors (PPIs) are widely used in acid-related disorders of the stomach and oesophagus. Treatment with PPIs is usually extended indefinitely for maintaining symptom control, putting the patient at risk of adverse effects. On the other hand, there is also a tendency for physicians to prescribe these drugs unnecessarily for minor dyspepsia. The use of these best-selling drugs is expected to increase further as they are now available over-the-counter in many countries . Several newer PPIs are now available on the market with claims of superior therapeutic efficacy which are also excessively prescribed without considering their cost-effectiveness. This article examines why PPIs are now the leading antisecretory drugs, clinical aspects to be considered when prescribing newer PPIs, indications and recommended duration of treatment in each situation, over-prescription of PPIs, and adverse reactions that can emerge with long-term use.