Preface

Abstract

In the past few years, data have accumulated on the potential risks of long-term use of proton pump inhibitors (PPIs) in patients with gastroesophageal reflux disease (GERD). The reports were initially sporadic, but we have recently noticed a stream of publications claiming a variety of adverse effects that may afflict patients who are chronically treated with PPIs. These studies have raised concerns among physicians and patients alike. In response to such publications, many physicians have altered their usual approach to the care of patients on chronic antireflux treatment for GERD. Thus far, however, there are no clear guidelines on how to manage GERD sufferers who are using PPIs on a daily basis. This clinical gap was the impetus for developing this supplement. We have assembled a highly reputable group of experts to discuss the full range of adverse events that have recently been attributed to long term PPI use. The authors were instructed to provide a detailed review incorporating all currently available publications on their relevant topic. Additionally, each expert was asked to critically evaluate these publications. Karl Insogna, an endocrinologist with expertise in calcium metabolism, discusses the effect of PPI therapy on mineral metabolism, and Kenneth McColl, a gastroenterologist with expertise in acid-peptic disorders, evaluates the effect of long term PPI use on vitamin and iron absorption. The relationship between PPI use and enteric infections is examined by Sandra Dial, a critical care physician with expertise in epidemiology. Nimish Vakil, a gastroenterologist with expertise in acid-peptic disorders, reviews the relationship between acid inhibition and infections outside the gastrointestinal tract. Loren Laine, also a gastroenterologist with expertise in acid-peptic disorders, provides a critical review of the relationship between PPI therapy and hip fracture. The overutilization of PPIs in clinical practice is discussed by Joel Heidelbaugh, a primary care physician with expertise in family medicine, and colleagues. Finally, Ronnie Fass, a gastroenterologist with interest in both acidpeptic disorders and gastrointestinal motility, describes therapeutic options for patients who failed PPI treatment. This timely supplement provides a critical review of the growing number of publications linking a variety of adverse events to long-term PPI treatment. The authors attempt to put into perspective all these publications and propose proper management of such patients. Clearly, in the face of overutilization of PPIs, concerns about adverse effects, and the increasing phenomenon of PPI failure, experts agree that PPIs should be used only in the proper patient population and for the duration required. CONFLICT OF INTEREST Guarantor of the article: Ronnie Fass, MD. Specific author contributions: Dr Fass conducted the research and wrote the preface and chapter entitled “Proton Pump Inhibitor Failure — What Are the Therapeutic Options?” Financial support: This work was supported by Glaxo Smith Kline. Potential competing interests: Dr Fass conducts research for Wyeth, Takeda, and AstraZeneca. He is a speaker for AstraZeneca and a consultant for AstraZeneca, Glaxo Smith Kline, Eisai, Takeda, Proctor & Gamble, Vecta, Addex, and Pfizer.