Guideline / position statementindependent cross-checkabstract only checked I-PPI-03 standard review
AGA advice on long-term PPIs
The Risks and Benefits of Long-term Use of Proton Pump Inhibitors: Expert Review and Best Practice Advice From the American Gastroenterological Association.
Overview
Freedberg DE et al.. Gastroenterology 2017 · PMID 28257716 · DOI 10.1053/j.gastro.2017.01.031
PPIs are justified for defined indications; risks do not require routine monitoring.
Does the study support the specific claim? No · Methodological quality: moderate
Plain-language summary
Study explained simply
- What did the researchers want to find out?
Risk–benefit guidance.
- How was the study done?
Expert review.
- What was actually found?
10 best practice statements.
- What do the results mean in everyday life?
Use for real indications at lowest dose.
- What are the study's limitations?
Expert opinion.
- What does it say about Elawady's specific claim?
Mixed: supports indication-based use.
- Do the results apply to Germany and Europe?
Applicable.
Scientific in-depth review
1. Full reference
- Authors
- Freedberg DE et al.
- Journal
- Gastroenterology
- Year
- 2017
- Identifier
- PMID 28257716 DOI 10.1053/j.gastro.2017.01.031
- Verification
- verified – PubMed efetch 2026-10-25
- Retracted
- no
- Corrections
- none
- Extent checked
- abstract only
- Conflicts of interest and funding
not stated in abstract
2. Research question
Risks and benefits of long-term PPI use for GERD, Barrett's oesophagus and NSAID bleeding prophylaxis
3. Study design and population
- Study design
- Guideline / position statement – Expert review and best practice advice (AGA), modified GRADE
- Population
Long-term PPI users
- Country
USA
- Period
literature to July 2016
4. Methods and endpoints
- Exposure / intervention
Long-term PPI
- Endpoints
Best practice advice
- Statistical methods
Expert opinion + literature
5. Actual results
- Results
BPA: PPIs for complicated GERD; attempt stop/reduce in uncomplicated GERD; long-term PPI in symptomatic Barrett's and consider in asymptomatic; PPI for high-risk NSAID users; periodic dose review; no routine probiotics, extra Ca/B12/Mg, or routine monitoring of BMD, creatinine, Mg, B12.
- Absolute risks
not applicable
- Authors' conclusion
Benefits outweigh risks for appropriate indications; use lowest effective dose.
6. Strengths
- Society guidance
7. Weaknesses
- Expert opinion
- Abstract only
8. Risk of bias
- Orienting tool
- none applicable
- Type of assessment
- simplified assessment (abstract only)
- Full formal assessment
- no
- Overall risk of bias
- not assessable
- Rationale
Expert review.
9. Assessment of the statistical interpretation
10. Relevance to the specific claim
Context for C-PPI-01–05, -10, -11.
11. Independent contrary findings
12. Transferability to Germany and Europe
High.
13. Overall methodological judgement
Balanced society view: risks small, indications matter.
| Multidimensional assessment | |
|---|---|
| Authenticity of the source | verified |
| Methodological quality | moderate |
| Risk of bias | not assessable |
| Precision of results | not applicable |
| Directness | direct |
| Reproducibility | unknown |
| Consistency with the overall evidence | consistent |
| Regional transferability | high |
| Adequacy of the interpretation (by the archive) | not applicable |
14. Open questions
15. Linked fact checks
- Long-term PPI use causes chronic kidney disease and excess deaths (about 45 extra deaths per 1,000 users, mainly from cardiovascular disease, kidney disease and upper gastrointestinal cancer). – Studies with mixed or unclear results
- Long-term acid suppression increases bacterial overgrowth, Clostridioides difficile and other enteric infections, and changes the gut microbiome. – Studies with mixed or unclear results
- Long-term acid suppression is linked to vitamin B12 deficiency and low magnesium. – Studies with mixed or unclear results
- Long-term acid suppression causes hip fractures and pneumonia. – Studies with mixed or unclear results
- All acid-suppressing medicines (PPIs and H2 blockers) are permanently forbidden; heartburn should stop through the diet, not through drugs. – Studies contradicting or limiting the claim
- PPIs are widely prescribed without a real indication (for example by doctors of other specialties to 'protect the stomach') and are now sold freely. – Studies with mixed or unclear results