Proton-pump inhibitors: understanding the complications and risks

Proton-pump inhibitors (PPIs) induce structural and functional changes in the gastric mucosa related to potent acid suppression, which are exaggerated during Helicobacter pylori infection; PPIs alone are unlikely to be related to gastric and gastrointestinal malignanciesThe list of adverse events associated with PPI intake is increasing; few of these associations are plausible or proven to have a causal relationshipThe risk of bacterial enteric infections with Clostridium difficile, Salmonella and Campylobacter is increased in patients on PPI therapy — this risk is low to modestPPI use can rarely cause acute kidney injury and other morbid conditions related to idiosyncratic effectsLong-term PPI intake interferes with magnesium and calcium homeostasis in small subsets of patients with chronic kidney disease on diuretic therapy; the prevalence of bone fractures attributable to PPIs in older patients is lowThe debate on whether PPIs increase the risk of coronary events in patients on clopidogrel seems to be resolved; the FDA recommends avoiding omeprazole in patients taking clopidogrel