Six stabs in the back of proton pump inhibitors

Abstract

Proton pump inhibitors (PPIs) are the most important class of drugs used for the therapy of acid-dependent diseases and states of the gastrointestinal tract (GIT). In rheumatologic practice, PPIs are an essential drug to treat and prevent upper GIT pathology occurring with the intake of antirheumatic (above all nonsteroidal anti-inflammatory) drugs. PPIs are noteworthy for ease of use, efficacy, and excellent tolerability. Nevertheless, they are able to cause a number of serious class-specific adverse reactions. Some of these complications, such as osteoporosis progression and metabolic effect of methotrexate, may be of great importance for rheumatologic practice. This review is a critical analysis of the data available in the literature on the safety of PPIs and a risk-benefit assessment when they are used