10 reasons to stay on your reflux medicines called Proton Pump Inhibitiors or PPIs?


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.