Nutritional Consequences of Long-term Acid Suppression; Are They Clinically Important?

David A. Johnson


Curr Opin Gastroenterol. 2016;32(2):136-140. 

In This Article

Abstract and Introduction


Purpose of review As acid suppression therapies with proton pump inhibitors are an extremely common practice for common acid-related diseases, there has been increased scrutiny on the safety of this class of therapy.

Recent findings There have been increasing reports of allegation of harm with the sustained use of proton pump inhibitors, in particular with potential adverse effects on vitamin and mineral absorption. This has prompted a number of product label changes directed by the US Food and Drug Administration, raising concerns for ongoing continued use among clinicians and patients.

Summary This review highlights the most recent information around these controversies and provides evidence summaries to help guide care providers in their care plans as well as discussions with patients.


Long-term acid suppressive therapy with proton pump inhibitors (PPIs) has been well tolerated and effective in patients with acid-related disease such as gastroesophageal reflux. In addition, these agents are also used as cotherapy prophylaxis in patients with other potentially ulcerogenic medication risks such as the use of NSAIDs or antiplatelet therapy. Given that some vitamin and mineral absorption may be affected by acid suppressive therapies (or acid ablative surgeries), recent reports of potential complications associated with chronic PPI use have prompted concerns and, in some cases, product label warnings mandated by the Food and Drug Administration (FDA). In many of these cases, there is evidence to support a potential association, yet study designs have largely prohibited the establishment of any causal relationships. This review aims to outline the physiologic basis for each of the reported risks and then explore the current evidence-based literature, finally offering a clinical evidence summary for each of the reported associations.