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Proton Pump Inhibitors: Review of Emerging Concerns
Nehra AK, Alexander JA, Loftus CG, Nehra V.. Mayo Clinic proceedings, 2018-02-01
Topic: Risk, prevention and care in population studies
First introduced in 1989, proton pump inhibitors (PPIs) are among the most widely utilized medications worldwide, both in the ambulatory and inpatient clinical settings. The PPIs are currently approved by the US Food and Drug Administration for the management of a variety of gastrointestinal disorders including symptomatic peptic ulcer disease, gastroesophageal reflux disease, and nonulcer dyspepsia as well as for prevention of gastrointestinal bleeding in patients receiving antiplatelet therapy. PPIs inhibit gastric acid secretion, and the most commonly associated adverse effects include abdominal pain, diarrhea, and headache. Although PPIs have had an encouraging safety profile, recent studies regarding the long-term use of PPI medications have noted potential adverse effects, including risk of fractures, pneumonia, Clostridium difficile diarrhea, hypomagnesemia, vitamin B 12 deficiency, chronic kidney disease, and dementia. These emerging data have led to subsequent investigations to assess these potential risks in patients receiving long-term PPI therapy. However, most of the published evidence is inadequate to establish a definite association between PPI use and the risk for development of serious adverse effects. Hence, when clinically indicated, PPIs can be prescribed at the lowest effective dose for symptom control.
Cite this study APA, Vancouver, BibTeX · download .bib or .ris
APA 7th
Nehra, A. K., Alexander, J. A., Loftus, C. G., & Nehra, V. (2018). Proton Pump Inhibitors: Review of Emerging Concerns. Mayo Clinic proceedings. https://doi.org/10.1016/j.mayocp.2017.10.022
Vancouver
Nehra AK, Alexander JA, Loftus CG, Nehra V. Proton Pump Inhibitors: Review of Emerging Concerns. Mayo Clinic proceedings. 2018. doi:10.1016/j.mayocp.2017.10.022. PMID: 29406201.
BibTeX
@article{nehra2018-29406201,
author = {Nehra, A. K. and Alexander, J. A. and Loftus, C. G. and Nehra, V.},
title = {{Proton Pump Inhibitors: Review of Emerging Concerns}},
journal = {Mayo Clinic proceedings},
year = {2018},
doi = {10.1016/j.mayocp.2017.10.022},
pmid = {29406201},
url = {https://doi.org/10.1016/j.mayocp.2017.10.022}
}
Built from the record alzhub holds for this paper, not looked up. Volume, issue and page numbers are not held in the record. Check the citation against the original before you use it.
Key findings
- PPIs inhibit gastric acid secretion, and the most commonly associated adverse effects include abdominal pain, diarrhea, and headache.
- Although PPIs have had an encouraging safety profile, recent studies regarding the long-term use of PPI medications have noted potential adverse effects, including risk of fractures, pneumonia, Clostridium difficile diarrhea, hypomagnesemia, vitamin B 12 deficiency, chronic kidney disease, and dementia.
- These emerging data have led to subsequent investigations to assess these potential risks in patients receiving long-term PPI therapy.
- However, most of the published evidence is inadequate to establish a definite association between PPI use and the risk for development of serious adverse effects.
- Hence, when clinically indicated, PPIs can be prescribed at the lowest effective dose for symptom control.
Why it matters
This review notes that long-term proton pump inhibitor use has been linked in some studies to potential adverse effects including dementia, but most published evidence is inadequate to establish a definite association. It concludes that when clinically indicated, proton pump inhibitors can be prescribed at the lowest effective dose for symptom control.
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Study details
- Evidence strengthLow
How this study scored 46/100
Published in a peer-reviewed journal. Scored zero for study design, sample size, effect reported, studied in people and randomised / blinded because the record does not state it.
| Component | Points | Why |
|---|---|---|
| Journal tier | 7 / 10 | Tier 3 — peer-reviewed journal (Mayo Clinic proceedings) |
| Journal's citation record | 3 / 4 | Mayo Clinic Proceedings: journal h-index 293 (OpenAlex, 2026-10-29) |
| Study design | 0 / 12 | No study design recorded — scores zero, not guessed (not stated in the record — scored 0) |
| Strength of evidence | 1 / 5 | Rated “low” in our summary |
| Peer-review validation | 10 / 10 | Peer-reviewed. Published as an article in a named peer-reviewed journal. |
| How recent | 2 / 5 | 2018 — within 10 year(s) of the newest study here |
| Sample size | 0 / 4 | Participant count not stated — scores zero (not stated in the record — scored 0) |
| Effect reported | 0 / 3 | No effect size reported — scores zero (not stated in the record — scored 0) |
| Studied in people | 0 / 3 | Not stated whether this was studied in people — scores zero (not stated in the record — scored 0) |
| Randomised / blinded | 0 / 2 | No randomisation or blinding stated — scores zero (not stated in the record — scored 0) |
| Times cited | 5 / 7 | Cited 250 times (OpenAlex, 2026-10-10) |
| Citations per year | 4 / 5 | 25.0 citations a year over 10 year(s) since 2018 |
| Impact for its field and year | 5 / 6 | Cited 23.6× the average for papers of its field and year (OpenAlex FWCI) |
| Cited by studies here | 0 / 6 | No other study in this library cites it |
| Still being cited | 3 / 4 | Cited 66 times in 2024–2026 (2026 still in progress; OpenAlex) |
| Senior author's track record | 2 / 4 | Last-listed author Vandana Nehra: h-index 21 (OpenAlex, whole career) |
| Institution's track record | 2 / 3 | Mayo Clinic: institution h-index 1,606 (OpenAlex) |
| Multi-centre collaboration | 0 / 3 | OpenAlex lists 1 institution(s) in 1 country — scores zero (affiliation lists can be incomplete) |
| Indexed in PubMed | 2 / 2 | Indexed in PubMed (PMID 29406201) |
| Free to read | 0 / 2 | Behind a paywall — scores zero |
| Total | 46 / 100 | — |
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