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Proton pump inhibitors (PPI) have been widely used since 1989 because they are highly effective for acid-related conditions. As a class, PPIs are among the safest of pharmacologic agents. In the last years concerns have risen regarding potential of adverse events due to PPI use. These include cancer risk (stomach and colorectal cancer), infection risk (pneumonia, Clostridium difficile associated diarrhea, small intestinal bacterial overgrowth, spontaneous bacterial peritonitis, interstitial nephritis), metabolic effects on bone density with osteoporotic fractures, alteration of absorption of vitamins and minerals and the pharmacodynamic interaction with the metabolism of other medications by the hepatic cytochrome P450 enzyme systems (e.g., clopidogrel). Almost the entire evidence base regarding the safety of PPI therapy is composed of retrospective non-randomized studies that demonstrate association but not causality and are limited by potential confounding factors. There is no evidence to support any benefit of changing existing clinical practice for preventing any of the potential adverse effects associated with PPI therapy. Therefore, in patients with appropriate indications for PPI, we should avoid continuous and high-dose therapy, considering on-demand therapy in suitable patients and step-down strategy

PROTON PUMP INHIBITORS BETWEEN BENEFITS AND RISKS