In this issue of Gastroenterology Klatte et al1 report an association of chronic kidney disease with proton pump inhibitor (PPI) use. This paper adds to the large number of observational studies suggesting an association of PPIs with different conditions. Many of these reports have attracted attention in the lay and professional press.2,3 Gastroenterologists are increasingly asked about the safety of long-term PPI therapy. Although the possibility of PPIs increasing the risk of adverse outcomes has resulted appropriately in scrutiny of patients taking PPIs for questionable indications or at doses higher than necessary, it has also produced exaggerated concerns by patients and physicians about appropriate PPI use.