Worldwide, proton pump inhibitors (PPIs) are being prescribed too often and in doses that are too high for long-term treatment because of incorrect indications. Therefore, PPIs may cause those symptoms that they are supposed to treat. Guideline-compliant indications for the long-term administration of PPIs are: proven gastroesophageal reflux disease (GERD), therapy with traditional nonsteroidal anti-inflammatory drugs (tNSAIDs) with a risk of or with manifest gastrointestinal bleeding, tNSAIDs with acetylsalicylic acid (ASS)/anti-platelets/direct oral anticoagulants (DOACs/vitamin K antagonists [VKAs]), therapy with ASS/anti-platelets/DOAK/VKA and risk factors or bleeding, therapy with ASS/COX-2-inhibitors and a history of or risk factors for gastrointestinal bleeding, simultaneous therapy with two active clotting substances (e.g., ASS and clopidrogel), or idiopathic bleeding with ulcers.
Potential long-term side effects of PPIs (dementia, Alzheimer’s disease, osteoporosis, interaction with clopidrogel, infection, malabsorption, allergies) are still under debate. Thus, meta-analyses currently exist that indicate a moderate risk, whereas other meta-analyses do not predict any dangers with regard to the long-term administration of PPIs. Patients have to be informed about these findings, because for the correct indication, PPIs are valuable medications, even for long-term therapy, and unnecessary fears should be avoided.