Can You Take PPI for 20 Years? A Look at the Long-Term Risks

October 9, 2025 •

4 min read

In Australia, the prevalence of Proton Pump Inhibitor (PPI) use was 12.6 per 100 people in 2016, with usage highest among those over 65 [1.7.2]. This widespread use raises a critical question: Can you take PPI for 20 years without significant health consequences?

Quick Summary

While some patients with severe conditions may require indefinite PPI therapy, taking them for two decades is associated with potential risks that require medical supervision. Concerns include nutrient deficiencies, bone fractures, and kidney issues.

Key Points

Not a Lifetime Drug for Most: PPIs are typically intended for short-term use (4-8 weeks); long-term use should be medically supervised for specific conditions [1.4.1, 1.4.2].
Documented Long-Term Risks: Chronic use is associated with risks like bone fractures, kidney disease, and C. difficile infections [1.2.1, 1.9.1].
Nutrient Malabsorption: Long-term use can lead to deficiencies in Vitamin B12, magnesium, and potentially calcium and iron [1.2.4, 1.8.3].
Deprescribing is Key: Medical guidelines recommend regularly re-evaluating the need for a PPI and attempting to reduce the dose or stop the medication when possible [1.4.6].
Rebound Symptoms are Common: Stopping PPIs abruptly can cause a temporary surge in acid production; tapering off is often recommended [1.2.2, 1.6.3].
Consult a Doctor: The decision to continue or stop a PPI should always be made with a healthcare provider to balance benefits against potential risks [1.2.2].

What Are Proton Pump Inhibitors (PPIs)?

Proton Pump Inhibitors (PPIs) are a class of drugs that powerfully reduce stomach acid production [1.3.2]. They work by blocking the enzymes in the stomach lining responsible for secreting acid [1.3.2]. This action makes them highly effective for treating conditions like gastroesophageal reflux disease (GERD), peptic ulcers, and preventing ulcers in patients taking nonsteroidal anti-inflammatory drugs (NSAIDs) [1.3.4]. Common PPIs include omeprazole (Prilosec), esomeprazole (Nexium), and pantoprazole (Protonix) [1.5.2]. For occasional heartburn, over-the-counter (OTC) PPIs are advised by the FDA for a 14-day course up to three times a year [1.2.2].

The Concern: Can You Take PPI for 20 Years?

While PPIs are considered safe for their recommended short-term course (typically 4-8 weeks), their widespread and often prolonged use has raised significant safety concerns [1.4.1, 1.2.4]. Many patients continue PPIs for years, sometimes without a clear, ongoing medical need [1.2.4, 1.7.5]. A study of older adults found that for 38% of those on long-term PPIs, there was no identifiable reason for the treatment [1.7.5].

Using a PPI for a period as long as 20 years is not standard practice and should only occur under strict medical supervision for specific, severe conditions. These may include Barrett's esophagus, a history of bleeding gastrointestinal ulcers, or severe erosive esophagitis [1.4.6]. For most patients, medical guidelines recommend regular re-evaluation and attempts to discontinue or reduce the dosage of the PPI [1.4.2, 1.4.3].

Documented Risks of Long-Term PPI Therapy

Observational studies have linked long-term PPI use to a variety of potential health risks, although a direct causal relationship is not always definitively established for all of them [1.2.3, 1.2.4].

Nutritional Deficiencies

By reducing stomach acid, PPIs can interfere with the absorption of essential micronutrients.

Vitamin B12: Chronic use, especially for more than two or three years, can lead to vitamin B12 deficiency, which may cause nerve damage [1.2.5, 1.8.5].
Magnesium: Hypomagnesemia (low magnesium) has been reported in users after as little as three months, but more commonly after a year or more. This can cause muscle weakness, cramps, and arrhythmias [1.2.4, 1.2.5].
Calcium and Iron: Reduced stomach acid can impair the absorption of calcium and iron, though the clinical significance for iron deficiency is debated [1.2.4, 1.8.2]. The impact on calcium absorption is a concern related to fracture risk [1.3.5].

Bone Fractures

Multiple studies and FDA warnings have highlighted an increased risk of hip, wrist, and spine fractures with long-term and high-dose PPI use [1.2.4, 1.3.4, 1.3.5]. This risk is believed to be linked to impaired calcium absorption [1.3.5].

Kidney Disease

Long-term use of PPIs has been associated with an increased risk of acute interstitial nephritis (a sudden kidney disorder) and chronic kidney disease (CKD) [1.2.4, 1.9.2].

Infections

Stomach acid serves as a defense mechanism against ingested pathogens [1.2.4]. By reducing this acid, PPIs may increase the risk of certain infections, including:

Clostridioides difficile (C. diff): This can cause severe diarrhea, particularly in hospitalized patients [1.2.4, 1.3.5].
Pneumonia: Some studies suggest a higher risk of community-acquired pneumonia [1.2.4].

Dementia and Other Concerns

An association between long-term PPI use and dementia has been explored, but the evidence remains inconsistent and debated [1.2.2, 1.9.4]. One study noted a 33% higher risk of dementia in those with over 4.4 cumulative years of use, but a causal link is not established [1.9.4]. Long-term use (especially over one year) can also cause fundic gland polyps, which are growths in the stomach lining [1.2.5].

Comparison Table: Short-Term Benefits vs. Long-Term Risks


Feature	Short-Term Use (4-8 weeks)	Long-Term Use (>1 Year)
Primary Goal	Heal esophagitis, treat ulcers, resolve acute GERD symptoms [1.4.2]	Manage chronic severe conditions like Barrett's esophagus or refractory GERD [1.4.6]
Efficacy	Highly effective for acid-related disorders [1.2.4]	Continued symptom control for indicated conditions [1.2.2]
Key Risks	Generally well-tolerated; may include headache, diarrhea, nausea [1.2.4]	Increased risk of fractures, nutrient deficiencies (B12, Magnesium), kidney disease, C. diff infection [1.2.1, 1.9.1]
Medical Guideline	Recommended for a defined course, followed by re-evaluation [1.4.2]	Re-evaluate annually; use the lowest effective dose for the shortest possible duration [1.4.3]

Safely Reducing or Stopping PPIs (Deprescribing)

For many patients, it's appropriate to attempt to stop or reduce PPI use, a process known as deprescribing [1.4.6]. This should always be done in consultation with a healthcare provider. Abruptly stopping can cause rebound acid hypersecretion, where symptoms return, sometimes worse than before [1.2.2].

Strategies for deprescribing include:

Tapering the Dose: Slowly reduce the dose over several weeks. For example, if you take it twice daily, reduce to once daily for a few weeks before stopping [1.6.5].
On-Demand Therapy: Switch from daily use to taking the medication only when symptoms occur [1.6.4].
Switching to an H2 Blocker: Use a less potent acid reducer like famotidine (Pepcid) to manage rebound symptoms during the tapering process [1.6.3].

Conclusion: A Question of Balance

So, can you take a PPI for 20 years? For a small subset of patients with severe, complicated acid-related diseases, the benefits might outweigh the risks under close medical watch [1.4.2]. However, for the vast majority of users, such prolonged use is not recommended and carries a profile of potential risks, from nutrient malabsorption to bone fractures and kidney problems [1.2.4, 1.9.1]. The guiding principle endorsed by medical experts is to use the lowest effective dose for the shortest duration necessary to control symptoms, with regular reviews to re-evaluate the need for continued therapy [1.2.4, 1.4.3].

For more information from an authoritative source, consider visiting the American College of Gastroenterology's patient information on GERD.

Frequently Asked Questions

The most cited concerns with long-term PPI use include an increased risk for bone fractures (hip, wrist, spine), deficiencies in vitamins and minerals like B12 and magnesium, kidney disease, and infections such as C. difficile [1.2.1, 1.9.1].

It is generally not recommended to stop taking a PPI abruptly, as it can lead to rebound acid hypersecretion, causing your symptoms to return, sometimes worse than before. A gradual taper, often with the guidance of a doctor, is the preferred method [1.2.2, 1.6.3].

Lifestyle modifications are a primary alternative, including weight loss, elevating the head of the bed, and avoiding trigger foods like spicy or fatty foods, caffeine, and alcohol [1.5.1]. Some people find relief with supplements like deglycyrrhizinated licorice (DGL) or by using apple cider vinegar, though evidence varies [1.5.2, 1.5.5].

The need for continued PPI therapy should be re-evaluated regularly with your healthcare provider. If your symptoms are resolved, your doctor may suggest a trial of dose reduction or discontinuation to see if the medication is still necessary [1.4.3].

Some studies have suggested a possible link between long-term PPI use and gastric cancer, but a definitive causal relationship has not been established and the evidence is conflicting [1.2.3, 1.3.3]. Guidelines recommend using PPIs for the shortest time necessary [1.3.3].

Long-term PPI use is most clearly linked to reduced absorption of Vitamin B12 and magnesium [1.3.4]. There are also concerns about impaired absorption of calcium and non-heme iron [1.2.4, 1.3.5].

While there are minor differences in how various PPIs are metabolized, current evidence does not suggest that one is significantly safer than others for long-term use. The associated risks are generally considered a class effect, applying to all PPI medications [1.5.3, 1.2.4].