TABLE 7.
Clinical indications for proton pump inhibitors: Corresponding benefits and potential risks.
| Clinical aspect | FDA-approved uses | Potential benefits | Potential risks | Monitoring/Clinical considerations |
|---|---|---|---|---|
| GERD (Gastroesophageal Reflux Disease) | Short- and long-term treatment of symptomatic GERD | Symptom control, healing of esophagitis | Rebound acid hypersecretion, potential masking of malignancy, adverse reactions of PPIs | Symptom assessment after 8 weeks of treatment |
| Erosive Esophagitis/Barrett’s Esophagus | Healing and maintenance of erosive esophagitis (FDA) | Reduction of dysplasia risk in Barrett’s esophagus | Long-term nutrient malabsorption, microbiota alterations | Endoscopic surveillance; continue if histologic/clinical benefit confirmed |
| NSAID/Antiplatelet Prophylaxis | Prevention of gastric ulcers associated with NSAID therapy (FDA for omeprazole, esomeprazole) | Protection against gastric or duodenal ulcer formation, Reduction of GI bleeding risk | Drug interactions (e.g., with clopidogrel), possible renal implications | Assessing the need for NSAID therapy, reducing the dose of PPIs |
| H. pylori Eradication Therapy | H. pylori eradication | Enhances antibiotic effectiveness | Minimal risks due to short-term treatment | Stop PPI after eradication confirmed |
| Zollinger–Ellison Syndrome | Treatment of peptic ulcers | Healing of peptic ulcers | Adverse reactions of PPIs | Monitor electrolytes and bone health during chronic high-dose use |
| Fracture Risk | Not an FDA indication | Not Applicable | Increased risk of bone fractures with long-term use due to the risk of developing osteoporosis | Consideration of DEXA scan in older adults or high-risk patients; supplement calcium + vitamin D if needed |
| Infection Risk | Not an FDA indication | Not Applicable | Risk of C. difficile infection, community-acquired pneumonia | Watch for unexplained diarrhea; avoid unnecessary antibiotic or PPI overlap |
| Nutrient Deficiency Risk | Not an FDA indication | Not Applicable | Vitamin B12, magnesium, and iron malabsorption | Yearly blood work in long-term treatment or elderly patients |
| Drug Interactions | Not an FDA indication | Not Applicable | CYP2C19-mediated (e.g., clopidogrel, methotrexate), digoxin potentiation | Prefer pantoprazole if interactions are a concern; reconcile medications regularly |
| Deprescribing Considerations | Not an FDA indication | Avoiding polypharmacy | Rebound hyperacidity, poor tapering can worsen outcomes | Taper slowly, consider using H2 blockers during transition off PPI |