Do Proton Pump Inhibitors Have Risks?

The most common side effects of PPI are:

  • Headache
  • Diarrhea
  • Constipation
  • Abdominal Pain
  • Flatulence
  • Joint Pain

Heartburn can be intense during pregnancy. Can I take medicine for  relief? Prilosec, Zegerid, Omeprazole are pregnancy category C meaning that adverse outcomes are reported in animal but not human studies. Aciphex, Nexium, Protonix, and pantoprazole are pregnancy category B. Antacids as Maalox, Tums, Mylanta, Gaviscon are pregnancy category B. Category B means that no reported adverse events are seen in animal studies, nor reported in humans. Human studies are not performed, so category A is only an abstraction.

Are there serious complications associated with PPI therapy?

Has there been any suggestion of increased heart disease with PPI therapy?

In 2007, a European study showed more cardiac events and deaths in the omeprazole treated patients than in the surgical patients. Later review showed that the surgery patients were substantially younger and healthier, and therefore suggest no true risk of heart disease.

FDA’s Safety Reviews of Prilosec and Nexium Find No Evidence of Increased Rates of Cardiac Events.

The detailed report.

Is osteoporosis due to PPI therapy?

Two important epidemiologic studies receiving a lot of press suggested an association. The problem with these studies is that they observe large numbers of people who have many differences between them other than just who takes PPI. For example, people taking PPI may be more likely to be obese (a proven fact), yet we should not suggest that PPI cause obesity. In fact the obesity may lead to more bone loss rather than the PPI. Maybe other medications not controlled for led to the fractures. It is known that acid decreases calcium tablet absorbtion, but not calcium food absorption.

We need acid to digest and absorb nutrients? Are vitamin deficiencies due to PPI therapy?

We need acid to protect the gut, an important portal of entry of bacteria. Are there infections related to PPI therapy?

Clostridium difficile infection (C. dif) can cause a serious bowel inflammation called pseudomembranous colitis. The risk is tripled with PPI treatment and doubled with H2 Blocker therapy, suggesting that acid is indeed an important defense barrier.

C. difficile infection

Link to


 Nosocomial pneumonia

Stomach Polyps

About the Author

Long Island's Premier Center for evaluation and treatment of Reflux, GERD, IBS, Eosinophilic Esophagitis, and Laryngopharyngeal Reflux. Dr. Gutman is the Director of Reflux Care of New York. He is a leading authority in the fields of Gastroesophageal Reflux Disorder (GERD), Laryngopharyngeal Reflux (LPR), Irritable Bowel Syndrome (IBS), Eosinophilic Esophagitis, and Non Cardiac Chest Pain. Dr. Gutman's approach to complicated digestive problems, utilizing a breadth of clinical experience with state of the art technologies has allowed him to benefit many patients who have struggled with GERD, LPR, IBS, Barrett's esophagus, Inflammatory Bowel Disease, and World Trade Center Syndrome. He is the only Long Island Gastroenterologist expert in Endoscopic Fundoplication (Esophyx), Transnasal Endoscopy, and the first to use Wireless esophageal acid testing without any nasal tubes. Demand the very best at Reflux Care.