The French National Authority for Health (HAS) has announced an information campaign to encourage healthcare professionals to limit the use of proton pump inhibitors. This initiative is justified, given the serious adverse effects associated with prolonged treatment. Proton pump inhibitors (PPIs) reduce gastric acid secretion by inhibiting the proton pump of the gastric wall (a). They are authorised for use in: oesophagitis; gastroesophageal reflux disease; and peptic ulcer disease, including the prevention of peptic ulcers for certain at-risk patients. In the short term, they have minor and infrequent adverse effects, mainly headache and gastrointestinal disorders. Stopping a PPI after a few weeks of treatment can lead to rebound acid hypersecretion, resulting in acid regurgitation and heartburn. When this occurs, patients are often tempted to resume treatment. Prolonged PPI use exposes patients to the risk of a multitude of sometimes serious harms, including: bacterial gastrointestinal or pulmonary infections; bone fractures, myalgia and arthralgia; hyponatraemia with hypomagnesaemia and hypocalcaemia; and immune-mediated interstitial nephritis. In addition, data on about 350 000 patients followed for almost 6 years showed higher mortality among patients receiving a PPI than among those receiving an H2-receptor anatagonist, and the risk increased with the duration of exposure (1,2).
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