Certain heartburn & acid reflux drugs linked to higher risk of death, disease

ST. LOUIS — Millions of people make a habit of taking heartburn medication to help with digestion, but a recent study suggests that taking certain types of heartburn and acid reflux medications for prolonged periods of time may not be a good idea.

Researchers from the Washington University School of Medicine in St. Louis have found a possible link between long-term use of certain kinds of heartburn and acid reflux medications called proton pump inhibitors (PPIs) and fatal cases of cardiovascular disease, chronic kidney disease, and upper gastrointestinal cancer.

The researchers discovered that these risks increase the longer a person takes PPIs, even at low doses. Over 15 million Americans are currently prescribed PPIs, and many more purchase PPIs over-the-counter.

“Taking PPIs over many months or years is not safe, and now we have a clearer picture of the health conditions associated with long-term PPI use,” says senior author Dr. Ziyad Al-Aly in a release.

Previous research had already linked PPIs to dementia, bone fractures, heart disease, pneumonia, and other health problems. Despite this, PPIs are still some of the most commonly used drugs in the nation.

Sold under a variety of different names, such as Prevacid, Prilosec, Nexium, and Protonix, PPIs reduce gastric acid and provide relief from heartburn symptoms and ulcers.

For the study, de-identified medical records maintained by the U.S. Department of Veterans Affairs were used. After looking over medical data from July 2002 to June 2004, 157,625 people, mostly Caucasian men aged 65 or older, who had been newly prescribed PPIs were identified. Another 56,842 people who had been newly prescribed a different kind of acid medicine called H2 blockers were also identified. Both groups, consisting of 214,467 patients in total, were then tracked for up to 10 years.

Researchers discovered that the PPI group had a 17% increased risk of death compared to the H2 blocker group. Per 1,000 studied patients, long-term PPI use was calculated to be attributable to 45 excess deaths (387 deaths per 1,000 in the PPI group, compared to 342 deaths per 1,000 in the H2 blockers group).

“Given the millions of people who take PPIs regularly, this translates into thousands of excess deaths every year,” Al-Aly comments.

The use of PPIs was associated with deaths caused by cardiovascular disease, upper gastrointestinal cancer, and kidney disease. Overall, 88 people from the PPI group died from heart disease, while 73 from the H2 blocker group died from heart disease. Similarly, six in the PPI group died from stomach cancer, while four died in the H2 blocker group, and eight PPI users died from chronic kidney disease compared to four in the H2 blocker group. So, that means that PPI use was associated with 15 heart disease-related deaths, four kidney disease deaths, and two stomach cancer deaths per 1,000 PPI users.

Perhaps most revealing of all was the discovery that more than half the people taking a PPI didn’t actually have a medical need for the drug. Unfortunately, data regarding why each patient was prescribed or starting taking a PPI in the first place was not available. Even more troubling, this group seemed to display a heightened risk of adverse effects. For every 1,000 people taking PPIs without medical need, nearly 23 died from heart disease, nearly five died from chronic kidney disease, and three died from stomach cancer.

“Most alarming to me is that serious harm may be experienced by people who are on PPIs but may not need them,” Al-Aly says. “Overuse is not devoid of harm.”

The study also noted that over 80% of studied PPI users were taking low doses, often found in over-the-counter PPI drugs.

“This suggests the risk may not be limited to prescription PPIs, but it also may occur at over-the-counter doses,” Al-Aly theorizes.

For now, researchers will continue to study PPIs and their adverse long-term effects. The FDA has already expressed interest in the work Al-Aly and his team are performing.

“PPIs sold over the counter should have a clearer warning about potential for significant health risks, as well as a clearer warning about the need to limit length of use, generally not to exceed 14 days,” Al-Aly concludes. “People who feel the need to take over-the-counter PPIs longer than this need to see their doctors.”

The study is published in the British Medical Journal.

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