Proton pump inhibitors (PPIs) are a class of drugs that reduce gastric acid secretion by inhibiting the H+/K+ ATPase enzyme in gastric parietal cells. PPIs are used to treat peptic ulcers, gastroesophageal reflux disease, non-ulcer dyspepsia, and heartburn and to prevent gastrointestinal bleeding or gastric ulcers in patients receiving antiplatelet drugs or nonsteroidal anti-inflammatory drugs (NSAIDs). They are among the most widely used medicines, both in the United States and worldwide.
The US Food and Drug Administration (FDA) recommends that PPI therapy be limited in most cases to two to eight weeks, although there are some indications for long-term use (such as Barrett’s esophagus, history of bleeding peptic ulcers, or chronic use of NSAIDs or certain other medications). However, physicians frequently prescribe PPIs for long-term or even lifetime use, and many people take over-the-counter PPIs for long periods of time with little or no supervision from a healthcare practitioner. It has been estimated that 53-89% of PPI prescriptions are inappropriate.1,2 One of the reasons that PPIs are used by so many people—an estimated 15 million Americans are taking these drugs—is that they are generally perceived to be safe for long-term use. However, a large body of evidence suggests that that perception is not correct.
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