Proton pump inhibitors: placing putative adverse effects in proper perspective

Area of Science:

• Gastroenterology
• Clinical Pharmacology
• Evidence-Based Medicine

Background:

• Proton pump inhibitors (PPIs) are frequently prescribed globally, often over-prescribed.
• While generally well-tolerated, large database studies suggest numerous potential adverse effects.
• Media and provider misinterpretations of low-quality evidence can lead to patient anxiety and underuse of necessary PPIs.

Purpose of the Study:

• To review recent clinical and basic science literature on potential adverse effects of PPIs.
• To address the quality of evidence linking PPIs to adverse events.
• To clarify the clinical implications of reported PPI-associated risks.

Main Methods:

• Comprehensive literature search of clinical and basic science studies published within the past year.
• Critical appraisal of the evidence quality for reported PPI-associated adverse effects.
• Synthesis of findings to provide a balanced perspective on PPI safety.

Main Results:

• Many reported PPI adverse effects are based on low-quality observational data.
• Prospective randomized trials have not confirmed most publicized serious adverse effects.
• Misinterpretation of data leads to unnecessary patient and provider concerns, potentially impacting appropriate PPI use.

Conclusions:

• PPIs should be prescribed only for valid indications.
• Long-term PPI use requires the lowest effective dose and periodic reassessment of necessity.
• Evidence supporting many claimed PPI adverse effects is weak, necessitating careful interpretation and communication.