Proton pump inhibitors (PPIs) like omeprazole, pantoprazole, and esomeprazole—are among the most commonly prescribed medications for gastroesophageal reflux disease (GERD).
Related condition guide: GERD

They’re effective. They’re widely used. And increasingly, patients are asking:

• “Is it safe to be on this for years?”

Over the last decade, observational studies have raised concerns about potential long-term risks of PPIs, including fractures, infections, kidney disease, and even dementia.

At the same time, professional societies and safety reviews emphasize that for many patients with clear indications, benefits outweigh risks, as long as therapy is appropriately indicated, dosed, and reviewed periodically.

This article summarizes current evidence and explores where personalized GERD therapy, including compounding, may fit.
Support resources: Help Hub

What Do PPIs Do and Why Are They So Popular?

PPIs:

• significantly reduce stomach acid production
• promote healing of erosive esophagitis
• reduce GERD symptoms and risk of complications (ulcers, strictures)
• are central in treatment of conditions like Barrett’s esophagus and high-risk ulcer disease

Many patients feel dramatically better on PPIs, leading to extended use, sometimes without regular reassessment.
Learn more about chronic reflux care: GERD

Long-Term PPI Use What Are the Potential Risks?

Multiple large observational studies and meta-analyses have reported associations between long-term PPI use and:

• Bone fractures (hip, wrist, spine)
• Chronic kidney disease (CKD) and acute kidney injury (AKI)
• Enteric infections (e.g., C. difficile, community-acquired pneumonia)
• Vitamin B12 and magnesium deficiencies
• Possible cognitive impacts (data mixed, may relate to B12 deficiency)

Important caveats:

• Most data are associative, not proof of causality.
• Patients on long-term PPIs are often older and have more comorbidities.
• Recent reviews emphasize that high-quality randomized data connecting PPIs to many of these risks are limited, and that risks are likely modest for most.

The conclusion from recent evidence reviews is nuanced:
For appropriate indications, the benefits of long-term PPIs generally outweigh potential risks, but therapy should be periodically re-evaluated and not continued “just because.”

Who Clearly Needs Long-Term PPIs?

Examples include:

• documented erosive esophagitis or Barrett’s esophagus
• high-risk NSAID or antiplatelet therapy with prior GI bleeding
• Zollinger–Ellison syndrome
• recurrent ulcer disease
• GERD with severe symptoms that recur when PPIs are stopped

In these cases, stopping PPIs can cause more harm than benefit.
For condition-level guidance: GERD

When Should GERD Treatment Be Reassessed?

For patients using PPIs primarily for uncomplicated heartburn:

• It may be appropriate to taper the dose
• try “on-demand” rather than continuous therapy
• or consider stepping down to H2 blockers or other approaches, under physician guidance

A structured discussion typically includes:

• “What was the original reason for starting this?”
• “Do I still have that risk or symptom pattern?”
• “Can we try a carefully supervised trial of dose reduction?”

More patient-friendly guidance and next steps: Help Hub

Where Personalized Therapy and Compounding May Help

Compounding for GERD is not about reinventing PPIs, but about supporting specific patient needs, for example:

1. Swallowing difficulties

ALS, severe esophageal disorders, or neurological conditions can make tablets difficult or dangerous to swallow.

Compounded liquid formulations of acid-suppressing medications, when appropriate, can help.
Related: ALS

2. Dose refinement

Some patients may need very gradual dose reductions to avoid rebound symptoms when tapering PPI therapy.

Compounded capsules or liquids can facilitate micro-tapering schedules under clinician guidance.

3. Excipient sensitivity

Rarely, dyes or fillers in certain products may provoke GI or dermatologic reactions.

Personalized formulations may omit non-essential excipients for these patients.

All of this must:

• be directed by a clinician
• respect existing GERD and PPI safety guidelines
• be compounded by a licensed pharmacy with robust quality standards

Support and medication-readiness resources: Help Hub

Questions to Ask Your Clinician About Your GERD Medications

• “Do I still need a daily PPI, or can we consider stepping down?”
• “What are my specific risks if I stop or reduce therapy?”
• “Could a different dose or formulation better match my current situation?”
• “How will we monitor for side effects or complications over time?”

Final Thoughts GERD Treatment Is a Long Game

For many patients, GERD is chronic. Managing it well means:

• using PPIs wisely when indicated
• avoiding unnecessary continuous therapy
• paying attention to lifestyle contributors (diet, weight, smoking, late meals)
• and tailoring medications to the realities of each patient’s health and abilities

AllMedRx supports this process by:

• providing personalized acid-suppressing medication formulations when clinically justified
• working closely with prescribers
• prioritizing safety and clarity whenever long-term therapy is on the table

To discuss personalized GERD medication formulations, clinicians can contact:
intake@allmedrx.org