PPI Heartburn drugs tied to higher risk of death

Common heartburn drugs tied to higher risk of death July 2017 – By Catharine Paddock PhD

A team of researchers from Washington University have found that a person’s risk of premature death rises with long-term use of PPIs. 

Interfering with our body’s biologic functions, like proton pump inhibitors do, always seems risky to me.

Because we cannot isolate the changes we make in one part of the system from the rest of it, there will always be unintended consequences; only time will tell if they are harmful or beneficial, but they will rarely be inconsequential.

Use of proton pump inhibitors – a class of drug taken by millions to treat heartburn and reduce stomach acid – is tied to a higher risk of premature death.

So concludes a large study that followed nearly 350,000 United States veterans. 

Reporting their findings in the journal BMJ Open, researchers from Washington University School of Medicine in St. Louis explain how they also found that the risk of death rose with longer use of proton pump inhibitors (PPIs).

The findings add to a growing list of serious health problems tied to the use of PPIs, some of which include

  • kidney damage,
  • Clostridium difficile infection,
  • bone fractures in people with osteoporosis, and
  • dementia.

Evidence is also emerging, although it is “far from conclusive,” that PPIs may raise the risk of tissue damage resulting from oxidative stress and telomere shortening in cells.

Telomeres are protective caps on the ends of chromosomes, which have been likened to the plastic ends on shoelaces that stop them unraveling.

PPIs are often overprescribed

PPIs work by reducing the amount of acid produced by the stomach.

They are widely prescribed for the treatment of heartburn, or acid reflux, a condition in which stomach acid is forced back up into the food pipe, or esophagus, causing a burning sensation in the lower chest.

If the condition persists, it could be a sign of a more serious problem called gastroesophageal reflux disease (GERD).

National survey results reveal that the proportion of U.S. adults using prescription PPIs nearly doubled in the decade or so leading up to 2012, having risen from 3.9 to 7.8 percent over that period.

The authors also cite estimates from studies that suggest that between half and two thirds of PPI prescriptions are for “inappropriate indications where benefits of PPI use may not justify the risks for many users.”

PPIs tied to 25 percent higher death risk

The team carried out three types of comparison.

These were:

  1. risk of death in PPI users and users of H2 blockers;
  2. risk of death in users and non-users of PPIs; and
  3. risk of death in users of PPIs and participants who used neither PPIs nor H2 blockers.

The results showed that compared with use of H2 blockers, use of PPIs was tied to a 25 percent raised risk of death from all causes.

Prof. Al-Aly says that since millions of people take PPIs on a regular basis, this could indicate that thousands of extra deaths each year are linked to PPI use.

He and his colleagues also found that the risk of death was higher among people who were using PPIs even though they appeared to have none of the gastrointestinal conditions that the drugs are recommended for.

Here, the results showed that compared with H2 blocker users, PPI users had a 24 percent raised risk of death.

PPI use should be assessed regularly

Compared with participants using H2 blockers, the PPI users in the study tended to be older – their average age was 64 compared with 61 in the H2 blocker group – and more likely to have illnesses such as diabetes, high blood pressure, and heart conditions.

The treatment recommendation for PPIs is that they should not be taken for a long time. In the case of ulcers, for example, the typical recommendation is between 2 and 8 weeks.

However, Prof. Al-Aly and colleagues note that many people can be on the drugs for months or even years.

Prof. Al-Aly also says that it is often the case that doctors have a good medical reason for prescribing PPIs to their patients, but then they do not stop, instead opting to keep refilling the prescription.

PPIs save lives. If I needed a PPI, I absolutely would take it.

But I wouldn’t take it willy-nilly if I didn’t need it.

And I would want my doctor to be monitoring me carefully and take me off it the moment it was no longer needed.”

 

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3 thoughts on “PPI Heartburn drugs tied to higher risk of death

    1. Zyp Czyk Post author

      Thanks for pointing out that PPIs are sometimes absolutely necessary too.

      While there is a very real need for these drugs, too many people who do not truly need them are taking them (for convenience, I suspect).

      It seems that stomach acid and reflux can often be managed by what is put into the stomach and when, but people prefer to eat as they like and then take a pill to correct the problems this causes them.

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      1. Laura P. Schulman, MD, MA

        Yes. Ayurveda teaches that the root of illness is bad diet. After my 10 weeks at the best Ayurvedic hospital in all India, trying to fix a genetic problem by eating foods that cause me to be ill (lactose and gluten), I understood that one size most definitely does not fit all!

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