Proton Pump Inhibitors: for What and for How Long

Proton pump inhibitors (PPIs) have been used for over 25 years and are valuable agents in treatment of acid-related disorders. Recently, literature has demonstrated an association of PPI use with various risks. The purpose of this comprehensive review is to summarize current evidence-based indications and treatment durations of PPIs. A PubMed literature search was performed to identify clinical studies evaluating efficacy and/or safety of PPI use for specific indications and relevant guidelines on PPI indications. As of 2019, the Food and Drug Administration of the USA has approved PPIs for the following: (1) gastrointestinal acid reflux disease, (2) peptic ulcer disease, (3) eradication of H. pylori, (4) non-steroidal anti-inflammatory drug-induced ulcers, and (5) Zollinger-Ellison syndrome. Non-FDA-approved indications with evidence of benefit include acute upper gastrointestinal bleeding, stress ulcer prophylaxis, short bowel syndrome, and allograft protection after lung transplant. PPIs are indicated for 4–8 weeks in the treatment of GERD, and peptic ulcer disease, 10–14 days in the treatment of H. pylori, up to 12 months in short bowel syndrome, and indefinitely in lung transplant.