There is little robust evidence available regarding potential adverse effects of PPIs (Proton Pump Inhibitors)

The benefits are likely to outweigh the risks when long-term prescribing is appropriate.

Below are the American Gastroenterological Association recommendations for PPI use

Best Practice Advice

• Advice 1: Patients with chronic gastro-esophageal reflux disease (GERD) and acid-related complications (ie, esophageal ulcers or erosions or stricture) should take a PPI for short-term healing, maintenance of healing, and long-term symptom control.
• Advice 2: Patients with uncomplicated GERD who respond to short-term PPIs should subsequently attempt to stop or reduce them. Patients who cannot reduce PPIs should consider esophageal pH monitoring before committing to lifelong PPIs to help distinguish GERD from a functional syndrome. The best candidates for this strategy may be patients with predominantly atypical symptoms or those who lack an obvious predisposition to GERD (eg, obesity, large hiatus hernia).
• Advice 3: Patients with Barrett’s esophagus (esophageal scarring) and symptomatic GERD should take a long-term PPI.
• Advice 4: Asymptomatic patients with Barrett’s esophagus should consider a long-term PPI.
• Advice 5: Patients at high risk for ulcer-related bleeding from NSAIDs (Anti-inflammatory therapy) should take a PPI if they continue to take NSAIDs.
• Advice 6: The dose of long-term PPIs should be periodically re-evaluated so that the lowest effective PPI dose can be prescribed to manage the condition.
• Advice 7: Long-term PPI users should not routinely use probiotics to prevent infection.
• Advice 8: Long-term PPI users should not routinely raise their intake of calcium, vitamin B12, or magnesium beyond the Recommended Dietary Allowance (RDA).
• Advice 9: Long-term PPI users should not routinely screen or monitor bone mineral density, kidney function, magnesium, or vitamin B12.
• Advice 10: Specific PPI formulations should not be selected based on potential risks.