What are the indications for long-term treatment with proton pump inhibitors (PPIs)?
Paul Moayyedi, MB ChB, PhD: There is a number of indications. Perhaps the one where it is most effective is reflux esophagitis where you do an endoscopy and you show a break in the lining of the mucosa. In such situations PPIs are very effective, with the number needed to treat of almost 1. Having said that, if you stop the PPI and assess it, the patients nearly always have a relapse, so the recommendation is to continue.
Following on from that would be heartburn where you do not know for sure they have reflux esophagitis but again it is reasonable to give a PPI. There is also functional dyspepsia where the main symptom is epigastric pain. Randomized trials do show PPIs are effective in that condition. Rarely, Helicobacter pylori–negative peptic ulcer disease would be a condition in which patients ought to have long-term PPI therapy. There is a number of other conditions, like noncardiac chest pain, or prophylaxis because the person has a high risk of gastrointestinal bleed. Those would be the main indications for a long-term PPI use.
PPIs are also used in H pylori eradication therapy but that is usually only for 2 weeks.