Proton pump inhibitors: Understanding the associated risks and benefits of long-term use.

This article reviews published data on adverse effects associated with proton pump inhibitors (PPIs), a widely prescribed class of acid-suppressing medications. It summarizes evidence linking PPIs to increased risks of bone fractures, acute and chronic kidney disease, gastrointestinal infections (notably Clostridioides difficile), and deficiencies in vitamin B12 and magnesium, though most findings derive from observational studies with methodological limitations. Randomized controlled trial data are limited but indicate an increased risk of enteric infections with chronic pantoprazole use. Despite these concerns, the American College of Gastroenterology continues to recommend PPIs as first-line therapy for gastroesophageal reflux disease and acute upper gastrointestinal bleeding, emphasizing that prolonged use should be regularly evaluated for ongoing necessity and benefit. The article concludes that higher-quality research is needed to clarify PPI-associated risks, and current evidence does not support widespread discontinuation solely based on safety concerns.