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Some good news – finally – about PPIs

So over the last several years, about the most maligned class of medications has been that group called proton pump inhibitors (PPIs), drugs that are highly effective at lowering acid output of the stomach, which is why they are used for a host of conditions but most prominently for the epidemic of acid reflux, a very fashionable diagnosis for a bunch of different digestive symptoms that a great many adults seem prone to.

And the thing about PPIs is that since they are so effective, they are incredibly over-prescribed, so although most guidelines recommending PPI treatment also recommend prescribing them only for a limited number of weeks, in reality, a huge number of people who go on them never seem to come off them.

That effect is also partly due to the fact that discontinuing a PPI results in an upsurge of the symptoms that caused a person to go on them in the first place – that’s what’s known as a rebound effect – so since it’s more comfortable to just get another dose of PPI to stop the nagging symptoms of “reflux” than to try to tough it out till things swing back to normal, that’s what far too many people do.

So PPIs have drawn a lot of attention the last few years, and most of it has been negative: PPI use has been related to higher risks of fractures (PPIs may interfere with the absorption of nutrients), infections (stomach acid helps fight off bacteria), even dementia.

But a recent review in the journal, Gastroenterology, has concluded that PPI use is not in fact related to a higher risk of dementia, pneumonia or intestinal infections.

Is that the final word on the subject?

Very very unlikely, and the bottom line is still that these drugs should be used with much more “respect”: for a limited amount of time in the lowest dose adequate to relieve symptoms, and every re-prescription should be carefully analyzed for its need.