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Long Term Proton Pump Inhibitor Therapy: Are We At Risk?

Julie A. Foont, MD Many patients ask about the possible risks associated with long term Proton Pump Inhibitor (PPI) therapy, including medications such as omeprazole, pantoprazole and lansoprazole. We know that these agents have been highly effective in the treatment of symptoms attributable to gastroesophageal reflux disease (GERD) and that they may also potentially mitigate damage to the lining of the esophagus that may be a consequence of prolonged acid exposure. Over the past decade, however, a number of studies have been published that have raised some concerns amongst those on PPI therapy, suggesting that long term use may possibly compromise bone density, increase the risk of developing dementia in older age and that there may also be an increased risk of adverse cardiovascular events (including heart attack). Now, a rigorously conducted, prospective, randomized trial has cast doubt on the credibility of most of these other findings. In this newer study published in 2019, nearly 17,600 patients with stable cardiovascular disease were randomly assigned to receive either a PPI (pantoprazole, 40 mg once daily) or a placebo medication. At an average follow-up of 3 years, there was no association found between PPI therapy and virtually all potential negative outcomes. The investigators found no significant risks of advanced dementia, the propensity to bone fracture, developing new-onset diabetes mellitus, as well as no increased incidence of chronic kidney disease, pneumonia, chronic obstructive pulmonary disease, gastric atrophy, or cancer.1 These results are encouraging and may be comforting to those who require longer-term PPI therapy for GERD or other acid-related conditions, suggesting that such treatment may indeed be safer than previously recognized. Nevertheless, as with any treatment option, we need to continually weigh the potential risks and benefits for any particular patient given their individual circumstances, and we encourage you to talk freely with your medical provider about any concerns that you may have. 1. Moayyedi P, et al. Safety of proton pump inhibitors based on a large, multi-year, randomized trial of patients receiving rivaroxaban or aspirin. Gastroenterology 2019; 157: 682-91.

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