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Proton pump inhibitors: increased mortality

Abstract

Proton pump inhibitors (PPIs) are widely used in oesophagitis, gastroesophageal reflux disease and peptic ulcer disease. They provoke few severe adverse effects in the short term, but this is not the case in the long term (infections, fractures, hyponatraemia, etc.).
A cohort study in about 350 000 patients in the United States, followed for 5.7 years, showed that patients receiving a PPI had a 25% increased risk of death compared with those receiving H2-receptor antagonists. In patients treated for more than one month, the risk appeared to increase with the duration of exposure. Other epidemiological studies have produced similar results.
These findings cast doubt on the harm-benefit balance of long-term and prophylactic PPI therapy. To address these risks, PPI withdrawal must be managed carefully and the use of alternative acid-suppressing agents should be considered.

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