PPIs play an important role in the management of many acid related disorders and are widely used throughout the world. In recent years a number of potential risks have been described some of which were based on observational studies and not confirmed on more careful analysis in randomized controlled trials. It has also become obvious that over treatment of patients with PPIs is a widespread phenomenon. As a result there is a need to balance risk and benefit in PPI therapy, selectively de-escalate therapy and ensure the need for continued therapy. These topics will be discussed in this session.