What are the potential side effects of long-term PPI use that I should discuss with my patients?

Long-term use of proton pump inhibitors (PPIs) can be associated with several potential side effects that should be discussed with patients. These include an increased risk of gastrointestinal infections such as Clostridium difficile, due to reduced gastric acidity impairing natural defence mechanisms. There is also a potential for nutrient malabsorption, particularly of magnesium, calcium, and vitamin B12, which may lead to hypomagnesaemia, bone fractures, and anaemia respectively. Additionally, chronic PPI use has been linked to an increased risk of chronic kidney disease and possibly dementia, although the evidence for the latter remains less definitive. Patients should also be informed about the risk of rebound acid hypersecretion upon abrupt discontinuation of PPIs, which can cause symptom recurrence. It is important to balance these risks against the benefits of PPI therapy, using the lowest effective dose for the shortest duration necessary, and regularly reviewing the indication for ongoing treatment to minimise potential harms ⁵,⁶,¹ (Begg et al., 2023).