Proton-Pump Inhibitors Probably Are Safe for at Least 3 Years of Chronic Use

Proton-pump inhibitors (PPIs) are very effective for reducing gastric acid secretion, and many patients take them chronically for relief of dyspepsia or heartburn. But observational studies, some widely publicized, have suggested that long-term PPI use might be associated with excess risk for pneumonia, fracture, enteric infections, Clostridioides difficile–related diarrhea, cerebrovascular events, chronic renal failure, dementia, and all-cause mortality. Guidelines advise that long-term treatment with PPIs be avoided wherever possible, and patients who rely on these drugs sometimes express concerns about their safety.

In the COMPASS trial, researchers randomized 27,000 patients with stable atherosclerotic disease to take rivaroxaban, aspiri…