Risks and Considerations of Long-Term Proton Pump Inhibitor / PPI Use

Proton pump inhibitors (PPIs) were a huge breakthrough in treating chronic acid reflux. Patients no longer had to rely on basic antacids to neutralize existing stomach acid, but now they could prevent much of the acid in their stomach from being produced in the first place. Initially, PPIs were sold by prescription only under the oversight of a qualified physician. However, over time, these drugs were eventually allowed to be sold over the counter and remain so today. Because of the significant incidence of reflux, you will likely see a large section of your local drugstore shelves dedicated to these drugs, generically known as omeprazole, amongst others. Brand names can include Zegerid, Prilosec, and Nexium.

It’s important not to be lulled into a sense that these drugs are to be taken casually since they are over the counter. There are substantial issues that every patient must understand.

First and most importantly, patients should know that PPIs should only be taken for six weeks. While this is clearly stated on the warning label, many patients ignore this, thinking that over-the-counter medications are safe. Taking these medications for longer than recommended substantially increases the risk for several concerns1, including:

Fracture risk: PPIs have been associated with an increased risk of fractures and osteoporosis possibly due to calcium malabsorption or other mechanisms.

Increased risk of GI infection: because of the elimination of the chemical barrier that stomach acid, patients are at a significantly higher risk for the proliferation of harmful bacteria in the stomach. This can include Clostridium difficile or C diff and foodborne illnesses, which can be very problematic to treat.

Rebound In Acid Production: many patients on long-term PPI therapy find that their stomach may produce more acid reflux after the drug is discontinued. This is known as rebound acid secretion.

Increased risk of dementia: Recent research has confirmed that patients taking PPIs for over four years have a more than 30% increased risk of developing dementia later in life.

It’s not all about the acid: it’s also important to realize that while acid production in the stomach is suppressed, PPIs do not stop gastric reflux. The composition of gastric juices, including digestive enzymes, is highly acidic to the more sensitive esophageal tissue, so even if patients do not experience significant discomfort, damage can still be done.

Alternatives to Long-term PPI Use

As a practice that sees an increasing number of patients with esophageal disorders caused by reflux, our first inclination is to encourage our patients toward improved diet and exercise to lose weight and reduce pressure on the lower esophageal sphincter. This is very effective in reducing the incidence of acid reflux. For patients who are not able to maintain an improved lifestyle or lower weight, various surgical options exist to treat the problem at its source. Dedicated acid reflux surgeries such as fundoplication and the LINX implant are good options for many. For patients who are also obese, gastric bypass can be an effective therapy while improving or eliminating reflux in almost all patients.

Most important, however, is to be evaluated by a qualified medical professional to understand your best course of action. Being under the care and supervision of a qualified ENT helps monitor the condition’s progression and identify potential treatment options that are best suited to the individual patient.

We encourage you to contact our office to schedule a consultation with Dr. Boger and learn more about the options for treating your reflux.

>Alternatives to Long-term PPI Use


  1. Ahmed A, Clarke JO. Proton Pump Inhibitors (PPI) [Updated 2023 May 1]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2023 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK557385/