Skip to main content

Thank you for visiting nature.com. You are using a browser version with limited support for CSS. To obtain the best experience, we recommend you use a more up to date browser (or turn off compatibility mode in Internet Explorer). In the meantime, to ensure continued support, we are displaying the site without styles and JavaScript.

The risks of PPI therapy

Nature Reviews Gastroenterology & Hepatology volume 9, pages 132–139 (2012)Cite this article

Subjects

Abstract

PPIs have become one of the most commonly used medications worldwide, as they are the treatment of choice for several acid-related gastrointestinal disorders. However, concerns have been raised about PPI therapy, including the risk of pneumonia, bone fractures and enteric infections, and a possible interaction with clopidogrel that could increase the risk of cardiovascular events. Observational studies have shown very modest associations between PPI therapy and these risks, although the association between PPI treatment and the risk of enteric infections seems to be stronger than the association with other risk factors. However, given the inherent limitations of observational studies, these associations could be attributable to bias and/or confounding factors. In addition, evidence from randomized, controlled trials does not support a clinically significant effect of PPI therapy on the risk of cardiovascular events in patients taking clopidogrel or the risk of pneumonia. Nevertheless, it is impossible to exclude the possibility that some of these associations might be causal or indeed that PPI therapy has an as yet unknown long-term adverse effect. As with any therapy, therefore, it is advisable to prescribe PPIs only to patients for whom these drugs have been proven beneficial.

Key Points

  • PPI therapy is associated with a risk of pneumonia, bone fracture and infective diarrhea; in patients taking clopidogrel, PPI therapy is associated with an increased risk of cardiovascular events

  • Many, if not all, of these associations are very modest, and, given the nature of observational studies, are probably attributable to confounding factors

  • The findings of randomized, controlled trials do not support a clinically important role of PPI therapy in reducing the effects of clopidogrel or in causing pneumonia

  • Although the possibility of adverse events attributable to PPI therapy cannot be excluded, it is important that PPIs are only given to patients who might benefit from them

This is a preview of subscription content, access via your institution

Access options

Rent or buy this article

Get just this article for as long as you need it

$39.95

Learn more

Prices may be subject to local taxes which are calculated during checkout

Figure 1: The duration of acid suppression intake is associated with the risk of pneumonia.18
Figure 2: An observational study has compared comorbidities in patients who were prescribed PPI therapy with those not given these drugs while evaluating the risk of pneumonia.16
Figure 3: An observational study has compared comorbidities in patients prescribed PPI therapy with the comorbidities of those not given these drugs while evaluating the risk of interaction with clopidogrel.79

References

  1. Moayyedi, P. & Axon, A. T. Review article: gastro-esophageal reflux disease—the extent of the problem. Aliment. Pharmacol. Ther. 22 (Suppl. 1), 11–19 (2005).

    Article  PubMed  Google Scholar 

  2. Fass, R. et al. The effect of dexlansoprazole MR on nocturnal heartburn and GERD-related sleep disturbances in patients with symptomatic GERD. Am. J. Gastroenterol. 106, 421–431 (2011).

    Article  CAS  PubMed  Google Scholar 

  3. Moayyedi, P. & Talley, N. J. Gastro-esophageal reflux disease. Lancet 367, 2086–2100 (2006).

    Article  PubMed  Google Scholar 

  4. Moayyedi, P. et al. The gain in quality-adjusted life months by switching to esomeprazole in those with continued reflux symptoms in primary care: EncomPASS—a cluster-randomized trial. Am. J. Gastroenterol. 105, 2341–2346 (2010).

    Article  CAS  PubMed  Google Scholar 

  5. Xiao, Y. L. et al. Prevalence and symptom pattern of pathologic esophageal acid reflux in patients with functional dyspepsia based on the Rome III criteria. Am. J. Gastroenterol. 105, 2626–2631 (2010).

    Article  PubMed  Google Scholar 

  6. Moayyedi, P., Delaney, B. C., Vakil, N., Forman, D. & Talley, N. J. The efficacy of proton pump inhibitors in nonulcer dyspepsia: a systematic review and economic analysis. Gastroenterology 127, 1329–1337 (2004).

    Article  PubMed  Google Scholar 

  7. Rostom, A., Moayyedi, P. & Hunt, R. Canadian consensus guidelines on long-term nonsteroidal anti-inflammatory drug therapy and the need for gastroprotection: benefits versus risks. Aliment. Pharmacol. Ther. 29, 481–496 (2009).

    Article  CAS  PubMed  Google Scholar 

  8. Leontiadis, G. I., Sharma, V. K. & Howden, C. W. Proton pump inhibitor treatment for acute peptic ulcer bleeding. Cochrane Database Syst. Rev. Issue 1. Art. no.: CD002094 http://dx.doi.10.1002/14651858.CD002094.pub4.

  9. Hassan-Alin, M., Andersson, T., Niazi, M. & Röhss, K. A pharmacokinetic study comparing single and repeated oral doses of 20 mg and 40 mg omeprazole and its two optical isomers, S-omeprazole (esomeprazole) and R-omeprazole, in healthy subjects. Eur. J. Clin. Pharmacol. 60, 779–784 (2005).

    Article  CAS  PubMed  Google Scholar 

  10. Scholl, S., Dellon, E. S. & Shaheen, N. J. Treatment of GERD and proton pump inhibitor use in the elderly: practical approaches and frequently asked questions. Am. J. Gastroenterol. 106, 386–392 (2011).

    Article  PubMed  Google Scholar 

  11. IMS Health [online], (2011).

  12. FDA. Possible fracture risk with high dose, long-term use of proton pump inhibitors [online], (2010).

  13. Vakil, N. Acid inhibition and infections outside the gastrointestinal tract. Am. J. Gastroenterol. 104 (Suppl. 2), S17–S20 (2009).

    Article  CAS  PubMed  Google Scholar 

  14. Laheij, R. J. et al. Risk of community-acquired pneumonia and use of acid-suppressive drugs. JAMA 292, 1955–1960 (2004).

    Article  CAS  PubMed  Google Scholar 

  15. Sarkar, M., Hennessy, S. & Yang, Y. X. Proton-pump inhibitor use and the risk for community-acquired pneumonia. Ann. Intern. Med. 149, 391–398 (2008).

    Article  PubMed  Google Scholar 

  16. Herzig, S. J., Howell, M. D., Ngo L. H. & Marcantonio, E. R. Acid-suppressive medication use and the risk for hospital-acquired pneumonia. JAMA 301, 2120–2128 (2009).

    Article  CAS  PubMed  Google Scholar 

  17. Johnstone, J., Nerenberg, K. & Loeb, M. Meta-analysis: proton pump inhibitor use and the risk of community-acquired pneumonia. Aliment. Pharmacol. Ther. 31, 1165–1177 (2010).

    Article  CAS  PubMed  Google Scholar 

  18. Eom, C. S. et al. Use of acid suppressive drugs and risk of pneumonia: a systematic review and meta-analysis. CMAJ 183, 310–319 (2011).

    Article  PubMed  PubMed Central  Google Scholar 

  19. Gulmez, S. E. et al. Use of proton pump inhibitors and the risk of community-acquired pneumonia: a population-based case-control study. Arch. Intern. Med. 167, 950–955 (2007).

    Article  CAS  PubMed  Google Scholar 

  20. Rodríguez, L. A., Ruigómez, A., Wallander, M. A. & Johansson, S. Acid-suppressive drugs and community-acquired pneumonia. Epidemiology 20, 800–806 (2009).

    Article  PubMed  Google Scholar 

  21. Horwitz, R. I. & Feinstein, A. R. The problem of “protopathic bias” in case-control studies. Am. J. Med. 68, 255–258 (1980).

    Article  CAS  PubMed  Google Scholar 

  22. Myles, P. R. et al. Risk of community-acquired pneumonia and the use of statins, ACE inhibitors and gastric acid suppressants: a population-based case control study. Pharmacoepidemiol. Drug Saf. 18, 269–275 (2009).

    Article  CAS  PubMed  Google Scholar 

  23. Sultan, N., Nazareno, J. & Gregor, J. Association between proton pump inhibitors and respiratory infections: a systematic review and meta-analysis of clinical trials. Can. J. Gastroenterol. 22, 761–766 (2008).

    Article  PubMed  PubMed Central  Google Scholar 

  24. Estborn, L. & Joelson, S. Occurrence of community-acquired respiratory tract infection in patients receiving esomeprazole: retrospective analysis of adverse events in 31 clinical trials. Drug Saf. 31, 627–636 (2008).

    Article  CAS  PubMed  Google Scholar 

  25. Leonard, J., Marshall, J. K. & Moayyedi. P. Systematic review of the risk of enteric infection in patients taking acid suppression. Am. J. Gastroenterol. 102, 2047–2056 (2007).

    Article  PubMed  Google Scholar 

  26. Kelly, C. P. & LaMont, J. T. Clostridium difficile—more difficult than ever. N. Engl. J. Med. 359, 1932–1940 (2008).

    Article  CAS  PubMed  Google Scholar 

  27. Kazakova, S. V. et al. A hospital outbreak of diarrhea due to an emerging epidemic strain of Clostridium difficile. Arch. Intern. Med. 166, 2518–2524 (2006).

    Article  PubMed  Google Scholar 

  28. Howell, M. D. et al. Iatrogenic gastric acid suppression and the risk of nosocomial Clostridium difficile infection. Arch. Intern. Med. 170, 784–790 (2010).

    Article  PubMed  Google Scholar 

  29. Aseeri, M., Schroeder, T., Kramer, J. & Zackula, R. Gastric acid suppression by proton pump inhibitors as a risk factor for Clostridium difficile-associated diarrhea in hospitalized patients. Am. J. Gastroenterol. 103, 2308–2313 (2008).

    Article  PubMed  Google Scholar 

  30. Naggie, S. et al. A case-control study of community-associated Clostridium difficile infection: no role for proton pump inhibitors. Am. J. Med. 124, 276.e1–7 (2011).

    Article  Google Scholar 

  31. Dial, S., Delaney, J. A., Barkun, A. N. & Suissa, S. Use of gastric acid-suppressive agents and the risk of community-acquired Clostridium difficile-associated disease. JAMA 294, 2989–2995 (2005).

    Article  CAS  PubMed  Google Scholar 

  32. Paredes-Sabja, D., Bond, C., Carman, R. J., Setlow, P. & Sarker, M. R. Germination of spores of Clostridium difficile strains, including isolates from a hospital outbreak of Clostridium difficile-associated disease (CDAD). Microbiology 154, 2241–2250 (2008).

    Article  CAS  PubMed  Google Scholar 

  33. Linsky, A., Gupta, K., Lawler, E. V., Fonda J. R. & Hermos, J. A. Proton pump inhibitors and risk for recurrent Clostridium difficile infection. Arch. Intern. Med. 170, 772–778 (2010).

    Article  PubMed  Google Scholar 

  34. Kim, J. W. et al. Proton pump inhibitors as a risk factor for recurrence of Clostridium-difficile-associated diarrhea. World J. Gastroenterol. 16, 3573–3577 (2010).

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  35. Pereira, S. P., Gainsborough, N. & Dowling, R. H. Drug-induced hypochlorhydria causes high duodenal bacterial counts in the elderly. Aliment. Pharmacol. Ther. 12, 99–104 (1998).

    Article  CAS  PubMed  Google Scholar 

  36. Dial, M. S. Proton pump inhibitor use and enteric infections. Am. J. Gastroenterol. 104 (Suppl. 2), S10–S16 (2009).

    Article  CAS  PubMed  Google Scholar 

  37. Hsu, J., Abad, C., Dinh, M. & Safdar, N. Prevention of endemic healthcare-associated Clostridium difficile infection: reviewing the evidence. Am. J. Gastroenterol. 105, 2327–2339 (2010).

    Article  CAS  PubMed  Google Scholar 

  38. Kwok, C. S., Yeong, J. K. & Loke, Y. K. Meta-analysis: risk of fractures with acid-suppressing medication. Bone 48, 768–776 (2011).

    Article  CAS  PubMed  Google Scholar 

  39. Ngamruengphong, S., Leontiadis, G. I., Radhi, S., Dentino, A. & Nugent, K. Proton pump inhibitors and risk of fracture: a systematic review and meta-analysis of observational studies. Am. J. Gastroenterol. 106, 1209–1218 (2011).

    Article  CAS  PubMed  Google Scholar 

  40. Eom, C. S., Park, S. M., Myung, S. K., Yun, J. M. & Ahn, J. S. Use of acid-suppressive drugs and risk of fracture: a meta-analysis of observational studies. Ann. Fam. Med. 9, 257–267 (2011).

    Article  PubMed  PubMed Central  Google Scholar 

  41. Yu, E. W., Bauer, S. R., Bain, P. A. & Bauer, D. C. Proton pump inhibitors and risk of fractures: a meta-analysis of 11 international studies. Am. J. Med. 124, 519–526 (2011).

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  42. Yang, Y. X., Lewis, J. D., Epstein, S. & Metz, D. C. Long-term proton pump inhibitor therapy and risk of hip fracture. JAMA 296, 2947–2953 (2006).

    Article  CAS  PubMed  Google Scholar 

  43. Vestergaard, P., Rejnmark, L. & Mosekilde L. Proton pump inhibitors, histamine H2 receptor antagonists, and other antacid medications and the risk of fracture. Calcif. Tissue Int. 79, 76–83 (2006).

    Article  CAS  PubMed  Google Scholar 

  44. Kaye, J. A. & Jick, H. Proton pump inhibitor use and risk of hip fractures in patients without major risk factors. Pharmacotherapy 28, 951–959 (2008).

    Article  CAS  PubMed  Google Scholar 

  45. Yu, E. W. et al. Acid-suppressive medications and risk of bone loss and fracture in older adults. Calcif. Tissue. Int. 83, 251–259 (2008).

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  46. Targownik, L. E. et al. Use of proton pump inhibitors and risk of osteoporosis-related fractures. CMAJ 179, 319–326 (2008).

    Article  PubMed  PubMed Central  Google Scholar 

  47. de Vries, F., Cooper, A. L., Cockle, S. M., van Staa, T. P. & Cooper, C. Fracture risk in patients receiving acid-suppressant medication alone and in combination with bisphosphonates. Osteoporos. Int. 20, 1989–1998 (2009).

    Article  CAS  PubMed  Google Scholar 

  48. Roux, C. et al. Increase in vertebral fracture risk in postmenopausal women using omeprazole. Calcif. Tissue Int. 84, 13–19 (2009).

    Article  CAS  PubMed  Google Scholar 

  49. Pouwels, S. et al. Use of proton pump inhibitors and risk of hip/femur fracture: a population-based case-control study. Osteoporos. Int. 22, 903–910 (2011).

    Article  CAS  PubMed  Google Scholar 

  50. Gray, S. L. et al. Proton pump inhibitor use, hip fracture, and change in bone mineral density in postmenopausal women: results from the Women's Health Initiative. Arch. Intern. Med. 170, 765–771 (2010).

    Article  PubMed  PubMed Central  Google Scholar 

  51. Corley, D. A., Kubo, A., Zhao, W. & Quesenberry, C. Proton pump inhibitors and histamine-2 receptor antagonists are associated with hip fractures among at-risk patients. Gastroenterology 139, 93–101 (2010).

    Article  PubMed  Google Scholar 

  52. Chonan, O., Takahashi, R., Yasui, H. & Watanuki, M. Effect of L-lactic acid on calcium absorption in rats fed omeprazole. J. Nutr. Sci. Vitaminol. 44, 473–481 (1998).

    Article  CAS  PubMed  Google Scholar 

  53. Goerss, J. B. et al. Risk of fractures in patients with pernicious anemia. J. Bone Miner. Res. 7, 573–579 (1992).

    Article  CAS  PubMed  Google Scholar 

  54. Nilas, L., Christiansen, C. & Christiansen, J. Regulation of vitamin D and calcium metabolism after gastrectomy. Gut 26, 252–257 (1985).

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  55. O'Connell, M. B., Madden, D. M., Murray, A. M., Heaney, R. P. & Kerzner, L. J. Effects of proton pump inhibitors on calcium carbonate absorption in women: a randomized crossover trial. Am. J. Med. 118, 778–781 (2005).

    Article  CAS  PubMed  Google Scholar 

  56. Wright, M. J. et al. Inhibiting gastric acid production does not affect intestinal calcium absorption in young, healthy individuals: a randomized, crossover, controlled clinical trial. J. Bone Miner. Res. 25, 2205–2211 (2010).

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  57. Hansen, K. E. et al. Do proton pump inhibitors decrease calcium absorption? J. Bone Miner. Res. 25, 2786–2795 (2010).

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  58. Targownik, L. E., Lix, L. M., Leung, S. & Leslie, W. D. Proton-pump inhibitor use is not associated with osteoporosis or accelerated bone mineral density loss. Gastroenterology 138, 896–904 (2010).

    Article  CAS  PubMed  Google Scholar 

  59. Yu, E. W. et al. Acid-suppressive medications and risk of bone loss and fracture in older adults. Calcif. Tissue Int. 83, 251–259 (2008).

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  60. Moayyedi, P. Hip fracture and proton pump inhibitor therapy: position statement. Can. J. Gastroenterol. 22, 855–858 (2008).

    Article  PubMed  PubMed Central  Google Scholar 

  61. Juurlink, D. N. et al. A population-based study of the drug interaction between proton pump inhibitors and clopidogrel. CMAJ 180, 713–718 (2009).

    Article  PubMed  PubMed Central  Google Scholar 

  62. van Boxel, O. S. et al. Cardiovascular and gastrointestinal outcomes in clopidogrel users on proton pump inhibitors: results of a large Dutch cohort study. Am. J. Gastroenterol. 105, 2430–2436 (2010).

    Article  CAS  PubMed  Google Scholar 

  63. Howden, C. W. PPIs and clopidogrel: the band plays on. Am. J. Gastroenterol. 105, 2438–2439 (2010).

    Article  PubMed  Google Scholar 

  64. Abraham, N. S. et al. ACCF/ACG/AHA 2010 expert consensus document on the concomitant use of proton pump inhibitors and thienopyridines: a focused update of the ACCF/ACG/AHA 2008 expert consensus document on reducing the gastrointestinal risks of antiplatelet therapy and NSAID use. Am. J. Gastroenterol. 105, 2533–2549 (2010).

    Article  PubMed  Google Scholar 

  65. Laine, L. & Hennekens, C. Proton pump inhibitor and clopidogrel interaction: fact or fiction? Am. J. Gastroenterol. 105, 34–41 (2010).

    Article  CAS  PubMed  Google Scholar 

  66. Leontiadis, G. I., Yuan, Y. & Howden, C. W. The interaction between PPIs and clopidogrel and upper gastrointestinal bleeding. Gastrointest. Endosc. Clin. N. Am. 21, 637–656 (2011).

    Article  PubMed  Google Scholar 

  67. Bhatt, D. L. et al. Clopidogrel with or without omeprazole in coronary artery disease. N. Engl. J. Med. 363, 1909–1917 (2010).

    Article  CAS  PubMed  Google Scholar 

  68. Hsu, P. I., Lai, K. H. & Liu, C. P. Esomeprazole with clopidogrel reduces peptic ulcer recurrence, compared with clopidogrel alone, in patients with atherosclerosis. Gastroenterology 140, 791–798 (2011).

    Article  CAS  PubMed  Google Scholar 

  69. O'Donoghue, M. L. et al. Pharmacodynamic effect and clinical efficacy of clopidogrel and prasugrel with or without a proton pump inhibitor: an analysis of two randomized trials. Lancet 374, 989–997 (2009).

    Article  CAS  PubMed  Google Scholar 

  70. Dunn, S. P. et al. Baseline proton pump inhibitor use is associated with increased cardiovascular events with and without the use of clopidogrel in the CREDO trial [abstract 3999]. Circulation 118, S815 (2008).

    Google Scholar 

  71. Hulot, J. S. et al. Cardiovascular risk in clopidogrel-treated patients according to cytochrome P450 2C19*2 loss-of-function allele or proton pump inhibitor coadministration: a systematic meta-analysis. J. Am. Coll. Cardiol. 56, 134–143 (2010).

    Article  CAS  PubMed  Google Scholar 

  72. Siller-Matula, J. M., Jilma, B., Schrör, K., Christ, G. & Huber, K. Effect of proton pump inhibitors on clinical outcome in patients treated with clopidogrel: a systematic review and meta-analysis. J. Thromb. Haemost. 8, 2624–2641 (2010).

    Article  CAS  PubMed  Google Scholar 

  73. Ngamruengphong, S., Leontiadis, G. I., Crowell, M. D., Chaliki, H. P. & Sharma, V. K. Risk of adverse cardiovascular events with concomitant use of clopidogrel and proton pump inhibitors (PPI): systematic review and meta-analysis of observational studies. [abstract T1078]. Gastroenterology 138 (Suppl. 1), S-483 (2010).

    Google Scholar 

  74. Kwok, C. S. & Loke, Y. K. Meta-analysis: the effects of proton pump inhibitors on cardiovascular events and mortality in patients receiving clopidogrel. Aliment. Pharmacol. Ther. 31, 810–823 (2010).

    CAS  PubMed  Google Scholar 

  75. Gerson, L. B., McMahon, D., Olkin I., Stave, C. & Rockson, G. L. Meta-analysis of interaction between clopidogrel and proton pump inhibitor therapy. [abstract W1108]. Gastroenterology 138 (Suppl. 1), S-653 (2010).

    Google Scholar 

  76. Mistry, S. D., Trivedi, H. R., Parmar, D. M., Dalvi, P. S. & Jiyo, C. Impact of proton pump inhibitors on efficacy of clopidogrel: review of evidence. Indian J. Pharmacol. 43, 183–186 (2011).

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  77. Lima, J. P. & Brophy, J. M. The potential interaction between clopidogrel and proton pump inhibitors: a systematic review. BMC Med. 8, 81 (2010).

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  78. Liu, T. J. & Jackevicius, C. A. Drug interaction between clopidogrel and proton pump inhibitors. Pharmacotherapy 30, 275–289 (2010).

    Article  PubMed  Google Scholar 

  79. Ho, P. M. et al. Risk of adverse outcomes associated with concomitant use of clopidogrel and proton pump inhibitors following acute coronary syndrome. JAMA 301, 937–944 (2009).

    Article  CAS  PubMed  Google Scholar 

  80. Moayyedi, P. & Sadowski, D. C. Proton pump inhibitors and clopidogrel—hazardous drug interaction or hazardous interpretation of data? Can. J. Gastroenterol. 23, 251–252 (2009).

    Article  PubMed  PubMed Central  Google Scholar 

  81. Niklasson, A., Lindström, L., Simrén, M., Lindberg, G. & Björnsson, E. Dyspeptic symptom development after discontinuation of a proton pump inhibitor: a double-blind placebo-controlled trial. Am. J. Gastroenterol. 105, 1531–1537 (2010).

    Article  CAS  PubMed  Google Scholar 

  82. Howden, C. W. & Kahrilas, P. J. Editorial: just how “difficult” is it to withdraw PPI treatment? Am. J. Gastroenterol. 105, 1538–1540 (2010).

    Article  PubMed  Google Scholar 

  83. Moayyedi, P. & Cranney, A. Hip fracture and proton pump inhibitor therapy: balancing the evidence for benefit and harm. Am. J. Gastroenterol. 103, 2428–2431 (2008).

    Article  CAS  PubMed  Google Scholar 

  84. Heidelbaugh, J. J., Goldberg, K. L. & Inadomi, J. M. Overutilization of proton pump inhibitors: a review of cost-effectiveness and risk. Am. J. Gastroenterol. 104 (Suppl. 2), S27–S32 (2009).

    Article  CAS  PubMed  Google Scholar 

  85. Saiz, L. C., Alvarez, J. & Martinez, H. Drug regulatory agencies' role in the interaction between clopidogrel and proton pump inhibitors. Am. J. Gastroenterol. 106, 1369–1370 (2011).

    Article  CAS  PubMed  Google Scholar 

  86. Moayyedi, P. Con: Evidence-based medicine—the emperor's new clothes? Am. J. Gastroenterol. 103, 2967–2969 (2008).

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Division of Gastroenterology, Department of Medicine, McMaster University, 1280 Main Street West, HSC Room 4W8E, Hamilton, L8S 4K1, ON, Canada

    Paul Moayyedi & Grigorios I. Leontiadis

Authors
  1. Paul Moayyedi
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Grigorios I. Leontiadis
    View author publications

    You can also search for this author in PubMed Google Scholar

Contributions

Both authors contributed equally to all aspects of this article.

Corresponding author

Correspondence to Paul Moayyedi.

Ethics declarations

Competing interests

P. Moayyedi has acted as a consultant for AstraZeneca, Axcan Pharma and Johnson & Johnson, and has received a research grant and speaking honoraria from Abbott, AstraZeneca, Johnson & Johnson and Nycomed. His chair is partially funded by an unrestricted donation given to McMaster University by AstraZeneca. G. I. Leontiadis has acted as a consultant for AstraZeneca and Axcan Pharma, and has received a research grant from AstraZeneca and speaking honoraria from AstraZeneca, Sanofi-Aventis and GlaxoSmithKline.

Rights and permissions

Reprints and Permissions

About this article

Cite this article

Moayyedi, P., Leontiadis, G. The risks of PPI therapy. Nat Rev Gastroenterol Hepatol 9, 132–139 (2012). https://doi.org/10.1038/nrgastro.2011.272

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1038/nrgastro.2011.272

This article is cited by

Search

Advanced search

Quick links

Nature Briefing

Sign up for the Nature Briefing newsletter — what matters in science, free to your inbox daily.

Get the most important science stories of the day, free in your inbox. Sign up for Nature Briefing