Proton pump inhibitors (PPIs) are commonly prescribed medications with increasing rates of use.1 PPIs are consistently 1 of the top 10 most prescribed drug classes,2 and several are available over the counter, resulting in increased self-directed use. Given their widespread use, there has been growing concern regarding the long-term safety profile of PPIs. A number of studies have reported potential adverse associations with long-term PPI therapy.3 However, many of these studies rely on observational data, which are susceptible to bias from multiple sources.