severe hypomagnesemia, refractory to supplemental therapy, has been reported with long-term PPI treatment [17]. The underlying biological mechanism is not known. Is is a rare condition and the association is based entirely on case reports. A total of 36 cases published since 2006 have been reviewed in two recent publication [18,19]. The symptoms reported were severe and included paraesthesiae, tetany, seizures, ataxia and GI symptoms and required hospitalization but resolved within 1-2 weeks once the PPI therapy was withdrawn. A limited number of cases appeared after only one yearsof PPI treament [20] with the majority of patients having received treatment for more than five years. The prevalence of asymptomatic milder degrees of hypomahnesaemia is unknown. Taking this and the rare occurrence into account there is most likely no benefit of routine magnesium measurements in all PPI users.