”The stomach is an organ where humans enjoy food and are not allowed to spend the whole day, and there are countless factors that can trigger gastric problems. Since patients with gastric problems often lack some kind of resistance mechanism, they are prone to recurrence and naturally need to take gastric medication frequently, and often patients think that the medication is ineffective and ask for “more powerful medication”. Clinically, it is definitely not a minority of outpatients who have been taking proton pump inhibitors for chronic gastritis for more than a year, and although these patients do change from time to time, they are mostly rolling in proton pump inhibitor drugs. Proton pump inhibitors are a professional term, abbreviated as PPI. speaking of specific drug names are almost household names: omeprazole (Losec, Oxy), pantoprazole, lansoprazole (Daclopromide), esomeprazole (Nexium), rabeprazole (Polite) are all famous. These drugs inhibit the ability of mural cells to secrete gastric acid at the root, so they have become a “powerful tool” in the treatment of acid-related gastric diseases such as gastric ulcer, duodenal bulb ulcer, reflux esophagitis, and Zor-El syndrome. Proton pump inhibitors are often not the mainstay of treatment for chronic gastritis, but are mainly used for gastric ulcers, duodenal ulcers, esophageal ulcers, Zor-El syndrome and for the eradication of H. pylori, a type of gastric disease that is characterized by high acid secretion. Chronic gastritis, especially atrophic gastritis, in which the gastric mucosal defense mechanism is weakened and acid secretion is low, is not an appropriate primary drug. Patients with chronic gastritis often take turns using various drugs such as proton pump inhibitors once, but the result may still be a “bad cure”, and many patients also suffer from bloating and other symptoms of indigestion. It is worth drawing serious attention to the world’s leading adverse drug reaction testing agency confirmed that the long-term use of proton pump inhibitors have safety risks At present, through close monitoring found that the long-term use of proton pump inhibitors more certain potential serious adverse reactions are three. Increased risk of hypomagnesemia It has been reported that the use of proton pump inhibitors for at least 3 months can cause hypomagnesemia, with most cases occurring after 1 year. In 1/4 cases, the hypomagnesemia can not be improved by magnesium supplementation alone, and the hypomagnesemia can be corrected only after the proton pump inhibitor is stopped. This hypomagnesemia is not easy to find, but can cause serious consequences. The manifestations of hypomagnesemia include fatigue, dizziness, twitching of the hands and feet, convulsions, tremors, palpitations and hypocalcemia. Increased risk of osteoporotic fractures Studies have found an increased risk of hip, wrist, and vertebral fractures with long-term use of proton pump inhibitor preparations for more than 6 months and in women over 50 years of age, especially in menopausal smoking women. Increased risk of pseudomembranous enteritis Due to the reduced acidity of the stomach and intestines, which favors the survival of Clostridium difficile and its spores, the risk of such enteritis increases 1.4 to 2.75 times in elderly people, patients on antibacterial drugs, patients who have undergone intestinal surgery, and patients who are immunocompromised for various reasons, if proton pump inhibitors are used at the same time. In this case, the use of general antibacterial drugs is not effective. 3 precautions Proton pump inhibitors have the above-mentioned side effects, therefore, patients should pay special attention to the following 3 issues when using proton pump inhibitors: 1. Control the course of treatment Adverse reactions to proton pump inhibitors basically occur in more than 3 months of continuous use, as seen in the increased risk of long-term use of drugs. Some varieties of proton pump inhibitors are over-the-counter drugs, which can be bought in pharmacies without a doctor’s prescription. The general recommendation is 14 days per course of treatment, two months apart. In this way, no more than 4 courses of treatment per year, there will be no adverse reactions as mentioned above. 2, choose the most appropriate disease use proton pump is most suitable for acid secretion of gastric disease use. This type of gastric disease patients are characterized by burning pain in the stomach, acid reflux, etc. Chronic gastritis may be more appropriate to use gastric mucosal protective agents and antacids, H2 receptor blockers. 3, special populations use caution Proton pump inhibitors of the above adverse reactions occur mostly in the simultaneous use of a variety of drugs. This situation is most prominent in the frail elderly, like hypertension, premature heartbeat, myocardial ischemia, swelling of the lower limbs is very common. These patients need to pay special attention to hypomagnesemia if they use proton pump inhibitors. There are also some patients who must take immunosuppressants for a long time, such as liver and kidney transplant patients, rheumatism patients, autoimmune liver disease patients, they often need to use proton pump inhibitors to protect the stomach, and take a long time, also need to pay special attention to observe the above-mentioned adverse reactions. Use with caution in pregnant women. Provide as much information as possible to your doctor about the various diseases you have and the medications you use during the consultation , before using proton pump inhibitors, patients should provide as much information as possible to their doctors about their other diseases and recent medications to help them assess whether the use of proton pump inhibitors may increase the risk of hypomagnesemia, osteoporosis, pseudomembranous enterocolitis. The physician will measure blood magnesium levels before and during the patient’s medication, as appropriate. Once hypomagnesemia is detected, magnesium intake should be supplemented and sometimes the dosage of proton pump inhibitors needs to be reduced or even discontinued to correct it. In short, the use of proton pump inhibitor adverse reactions occur mostly in the long-term continuous application, therefore, patients should use as short as possible, intermittent use. During the use of proton pump inhibitors should also be closely observed adverse reactions, once the appearance of abnormal discomfort should be promptly to seek medical advice, so that doctors can determine the relevance of these symptoms and the drugs used to take appropriate measures to prevent serious adverse reactions.