Research Unit of General Practice, Department of Public Health, University of Southern Denmark, Odense C, Denmark.
Basic Clin Pharmacol Toxicol. 2018 Aug;123(2):114-121. doi: 10.1111/bcpt.13023. Epub 2018 May 24.
Proton pump inhibitors (PPIs) are widely used, and concerns about overuse have been raised. Therefore, side effects are important to be aware of and several suggested side effects of long-term use have been studied. In this MiniReview, we sum up the evidence of side effects related to long-term PPI treatment. Suspected side effects are mainly related to increased susceptibility to infections, secondary hypergastrinaemia, impeded absorption of micronutrients or idiosyncratic reactions. Most of the potential side effects have only been evaluated in observational studies demonstrating conflicting and weak associations with a substantial risk of confounding. However, a high probability of causality seems to be established for the side effects increased risk of gastrointestinal infections and rebound acid hypersecretion following discontinuation of treatment due to secondary hypergastrinaemia. The risk of side effects should not be a reason to withhold PPIs from patients with a true indication, and worry about poorly proven side effects should not lead to unnecessary discontinuation. The most important safety issue regarding PPI therapy is to critically evaluate the indication when initiating treatment and reconsidering the indication in long-term-treated patients.
质子泵抑制剂（PPIs）被广泛应用，但人们对其过度使用的问题表示担忧。因此，了解药物的副作用非常重要，目前已经有研究针对长期使用 PPI 可能产生的副作用进行了探讨。在这篇 MiniReview 中，我们总结了与长期 PPI 治疗相关的副作用证据。疑似副作用主要与感染易感性增加、继发性高胃泌素血症、微量营养素吸收障碍或特发性反应有关。大多数潜在的副作用仅在观察性研究中进行了评估，这些研究显示出与混杂因素相关的冲突和弱关联，存在较大的混杂风险。然而，由于继发性高胃泌素血症导致停药后胃肠道感染风险增加和酸分泌反跳，这些副作用的因果关系似乎非常高。副作用的风险不应成为对真正有适应证的患者拒绝使用 PPI 的理由，对尚未充分证实的副作用的担忧也不应导致不必要的停药。关于 PPI 治疗，最重要的安全问题是在开始治疗时批判性地评估适应证，并在长期治疗的患者中重新考虑适应证。
