What are the risks of long-term PPI use for GERD symptoms in patients > 65 years?

Abstract

Q: What are the risks of long-term PPI for GERD symptoms in patients > 65 years? EVIDENCE-BASED ANSWER: THE USE OF PROTON PUMP INHIBITORS (PPIs) to control gastrointestinal esophageal reflux disease (GRED) is significantly associated with increased risk of cardiovascular events such as acute myocardial infarction and myocardial ischemia, especially with treatment longer than 8 weeks (strength of recommendation [SOR]: A, systematic review of randomized, controlled trials [RCTs]). This summary is based on data extrapolated from studies on all adults because there is limited evidence that specifically addresses patients older than 65 years. Adults taking PPIs also appear to be at increased risk of Clostridium difficile infection, community-acquired pneumonia (CAP; with use for < 30 days), and fracture (SOR: B, systematic reviews of heterogeneous prospective and retrospective observational studies).