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The safety of prolonged gastric acid suppression remains unclear. A recent large randomized trial supported the overall safety of proton-pump inhibitors (PPIs) for as long as 3 years of continuous use (NEJM JW Gen Med Sep 15 2019 and Gastroenterology 2019; 157:682). However, other studies have shown these agents to cause subtle alterations in the gut microbiome, which might well remain unapparent for long periods and go on to cause substantial morbidity.
Because of reports associating PPI use with carriage of multidrug-resistant microorganisms (MDROs; e.g., Clin Infect Dis 2017; 64:361), Dutch researchers constructed a meta-analysis that incorporated results from 26 studies with ≈30,000 patients, 40% of whom took PPIs or histamine-2 (H2) blo…