Long term effects of PPI

Long term PPI use is associated with the following effects. The level of evidence for such association is sparse. Clinician must be aware of the following risks and take appropriate measure if required. 

• Vitamin B12 deficiency
• Increased risk of fractures (osteoporosis)
• Hypergastrinemia
• Increased risk of infections: nosocomial pneumonia, community acquired Clostridium difficile, SBP in ascites