Science

Ami Kapadia, MD, Daisy Wynn, MD, and Brooke Salzman, MD

Since the introduction of omeprazole in 1989, proton pump inhibitors (PPIs) have become one of the most commonly prescribed classes of medications in the world. In 2007, PPI sales in the United States were in excess of $11 billion.1 Esomeprazole and lansoprazole both ranked among the top five drugs sold in the United States in 2007. Overall, with their high safety profile and demonstrated efficacy, PPIs represent a major advance in the treatment of acid ­related disorders ranging from peptic ulcer disease to erosive esophagitis. However, it has been shown that PPIs are often misused and overused, which may have significant implications.2­7 With the widespread and frequent long ­term use of PPIs, several adverse effects have come to light that may call for more selective prescribing practices, particularly in older adults who may be more vulnerable and likely to suffer the consequences of such adverse effects. With an estimated 8% of males and 15% of females age 65 years and older experiencing reflux and potentially using acid ­suppressive therapy, 8 understanding the risks for potential adverse effects associated with PPIs is critical in this population. In this article, we review the current data on selected negative outcomes that may result from PPI use. Specifically, increasing evidence demonstrates that PPI therapy may be associated with the development of Clostridium difficile infections, hip fractures, community­ acquired pneumonia, vitamin B12 deficiency, and possibly immunoglobulin E–mediated allergic reactions. The implications of such adverse outcomes, along with the evidence of the inappropriate use of PPIs, underscore the need for more judicious use of this class of medications.