The last two decades have seen the introduction and rapid rise in popularity of the proton pump inhibitors (PPI) for GORD & gastric ulcers. While clinical trials prior to their approval and release didn’t reveal much in terms of adverse reactions, being not dissimilar to the side effects of the previous acid suppressing drugs, more recent studies involving larger numbers of individuals and post-marketing surveillance have raised several concerns about their chronic use. The three key current areas of concern are
- the potential for increased bone fracture
- increased susceptibility to infections
- altered gastric function – digestive and nutritional consequences
While more targeted research is needed to fully clarify any causal role of the PPIs, there is a growing body of evidence which points to potentially serious detrimental effects for some long-time users. Increased rates of small intestinal overgrowth (SIBO), Clostridium difficile associated diarrhoea (CDAD) and other enteric infections highlight the negative impact gastric acid suppression has on host defence & eubiosis. While the nutritional consequences, initially thought to be limited to impaired nutrient digestion and absorption are now extending to the sudden development of IgE food allergies in PPI–taking patients. There is also new information about how PPIs interact with other medications both within the GIT and via CYP450 system. If you’re interested in learning more about this widely prescribed class of drugs check out a recent Medscape review on the topic https://www.medscape.com/viewarticle/730747