Navigating the Long-Term Use of Proton Pump Inhibitors: Clinical Efficacy and Safety Concerns
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Abstract
Proton pump inhibitors (PPIs) have been extensively used for over two decades as the cornerstone therapy for acid-related gastrointestinal disorders, including gastroesophageal reflux disease, peptic ulcer disease, and Zollinger-Ellison syndrome. Their clinical efficacy in suppressing gastric acid secretion and promoting mucosal healing is well established. However, widespread and often prolonged use has prompted growing concerns regarding safety issues associated with long-term therapy. This article provides a comprehensive review of the current evidence on the clinical benefits and potential risks of extended PPI use. Common adverse effects such as nutrient malabsorption (magnesium, calcium, vitamin B12), increased susceptibility to infections (Clostridioides difficile, pneumonia), renal complications, and possible cardiovascular and gastrointestinal risks are discussed in detail. The role of pharmacovigilance data in monitoring these safety concerns is highlighted. Additionally, evidence-based deprescribing strategies are presented to guide appropriate tapering and discontinuation of PPIs when long-term use is not warranted. The critical involvement of clinicians and pharmacists in ensuring rational prescribing, patient education, and adverse effect management is emphasized. Lifestyle modifications that may reduce dependence on pharmacologic therapy are also reviewed. This balanced overview underscores the importance of individualized therapy, regular reassessment, and interdisciplinary collaboration to optimize patient outcomes while minimizing adverse events related to long-term PPI therapy.