Long-term use of proton pump inhibitors has been associated with which risk?

• A. Clostridioides difficile infection
• B. Hypermagnesemia
• C. Improved iron absorption
• D. Decreased risk of pneumonia

Answer: (A)

Long-term acid suppression with proton pump inhibitors lowers gastric acidity, which weakens the stomach’s barrier to ingested pathogens and can alter the gut microbiome. This creates a favorable environment for Clostridioides difficile to thrive in the colon, making infection more likely with prolonged PPI use.

Hypermagnesemia isn’t a typical effect; in fact, long-term PPI use can lead to magnesium deficiency. Iron absorption tends to worsen with reduced stomach acid, since acid helps solubilize iron, so improved iron absorption wouldn’t occur. The risk of pneumonia is generally increased with PPI use, not decreased, due to factors like altered bacterial flora and microaspiration, so decreased risk isn’t correct.