Department of Medicine and Division of Gastroenterology and Hepatology, Stanford University School of Medicine, Stanford, CA 94305, USA.
Dig Dis Sci. 2011 Apr;56(4):931-50. doi: 10.1007/s10620-010-1560-3. Epub 2011 Mar 2.
Proton pump inhibitors have an excellent safety profile and have become one of the most commonly prescribed class of drugs in primary and specialty care. Long-term, sometimes lifetime, use is becoming increasingly common, often without appropriate indications. This paper is a detailed review of the current evidence on this important topic, focusing on the potential adverse effects of long-term proton pump inhibitor use that have generated the greatest concern: B12 deficiency; iron deficiency; hypomagnesemia; increased susceptibility to pneumonia, enteric infections, and fractures; hypergastrinemia and cancer; drug interactions; and birth defects. We explain the pathophysiological mechanisms that may underlie each of these relationships, review the existing evidence, and discuss implications for clinical management. The benefits of proton pump inhibitor use outweigh its risks in most patients. Elderly, malnourished, immune-compromised, chronically ill, and osteoporotic patients theoretically could be at increased risk from long-term therapy.
质子泵抑制剂具有极好的安全性，已成为初级保健和专科医疗中最常用的药物之一。长期（有时甚至是终身）使用质子泵抑制剂的情况越来越常见，但通常没有适当的用药指征。本文详细回顾了这一重要主题的现有证据，重点关注了长期使用质子泵抑制剂引起的最令人担忧的潜在不良反应：维生素 B12 缺乏症、缺铁症、低镁血症、肺炎、肠道感染和骨折易感性增加、高胃泌素血症和癌症、药物相互作用以及出生缺陷。我们解释了这些关系可能存在的病理生理学机制，回顾了现有证据，并讨论了对临床管理的影响。在大多数患者中，质子泵抑制剂的使用利大于弊。但长期治疗可能会使老年、营养不良、免疫功能低下、患有慢性疾病和骨质疏松症的患者面临更高的风险。
