Risks and Management of Chronic PPI Use in the Elderly

Introduction to Risks

The European Society of Cardiology recommends that PPIs be used with caution in elderly patients, as they are potentially inappropriate medications (PIMs) when used for more than 12 weeks without documented chronic disease or ongoing risk factors 1

Community-acquired pneumonia has been associated with PPI use in observational studies, with higher doses showing stronger associations, according to the American Gastroenterological Association 2

The American Gastroenterological Association recommends that all elderly patients on chronic PPIs should have their indication reviewed and documented, and that definite indications for long-term use include Barrett's esophagus, severe erosive esophagitis, and gastroprotection in high-risk NSAID/aspirin users 2
The European Heart Society suggests that PPIs are appropriate for elderly patients on antithrombotic therapy who have multiple risk factors for GI bleeding, including history of upper GI bleeding, multiple antithrombotic agents, age >60 years with aspirin/NSAID use, and concurrent corticosteroid use 3, 4
The American Gastroenterological Association recommends that patients on dual antiplatelet therapy or multiple antithrombotics should continue gastroprotection with PPIs for as long as antithrombotic therapy is administered, and that patients without definitive indications should be considered for trial of PPI discontinuation 2, 4

The European Society of Cardiology recommends using the minimum effective dose for the shortest duration appropriate to the condition, and periodically reassessing the clinical rationale for continued use 1