Department of Medicine, University of Wisconsin School of Medicine and Public Health, Madison WI, USA.
Drugs. 2012 Mar 5;72(4):437-45. doi: 10.2165/11599320-000000000-00000.
Proton pump inhibitors (PPIs) are among the most widely used agents in the world. The prevalence of reflux disease is increasing, as is the incidence of oesophageal adenocarcinoma, a complication that is strongly correlated with chronic reflux disease. Although these agents are generally safe, a number of potential side effects have been described and a careful assessment of the risks and benefits of PPI therapy is required in all patients being prescribed long-term therapy. Overutilization of PPIs is a problem in clinical practice and needs further attention. PPI use has been associated with osteoporosis and bone fracture, hypomagnesaemia, the development of gastric polyps, enteric infections, interstitial nephritis and pneumonia. Patients on long-term therapy should be periodically evaluated for the indications for continued therapy. Despite widespread publicity in the lay press, and regulatory guidance regarding a number of associations, the evidence for serious side effects is poor and the risk of confounding remains a real possibility for many associations. Patients are more concerned about the absolute risk of developing a complication than a relative risk. The absolute risk of all the complications attributed to PPIs is low and patients who need long-term PPI therapy need a clear discussion of the available data on the risk of therapy and also a discussion of the risk of continued reflux.
质子泵抑制剂（PPIs）是世界上应用最广泛的药物之一。反流性疾病的患病率正在增加，食管腺癌的发病率也在增加，这种并发症与慢性反流性疾病密切相关。尽管这些药物通常是安全的，但已经描述了一些潜在的副作用，需要对所有接受长期治疗的患者进行 PPI 治疗的风险和益处进行仔细评估。PPIs 的过度使用是临床实践中的一个问题，需要进一步关注。PPIs 的使用与骨质疏松症和骨折、低镁血症、胃息肉的发展、肠道感染、间质性肾炎和肺炎有关。长期接受治疗的患者应定期评估继续治疗的适应证。尽管在大众媒体和一些监管指南中广泛宣传，但对于严重副作用的证据仍然不足，对于许多关联，混杂的风险仍然是一个现实的可能性。患者更关心发生并发症的绝对风险，而不是相对风险。归因于 PPI 的所有并发症的绝对风险都很低，需要长期 PPI 治疗的患者需要对治疗风险的现有数据进行明确讨论，还需要讨论继续反流的风险。
