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Heartburn and PPI’s: Do the Risks Outweigh the Benefits?

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With over 21 million people in the US (the estimate in 2009) taking medications called proton pump inhibiters, or PPI’s, (which include Nexium, Prilosec and Prevacid) new medical studies raise some alarms about the safety of these medications.

When I reported on this topic in June of 2015, researchers had recently discovered a connection between using PPI’s and heart attacks, “Using a technique called data mining, the researchers went through 16 million electronic records, from 2.9 million patients, and found that “people who take the medication to suppress the release of stomach acid are 16 percent to 21 percent more likely to suffer myocardial infarction, commonly known as heart attack.”

So far this year medical researchers have found three more studies that bring the focus back on the concerns about popular heartburn medications, specifically PPI’s. An article in the January edition of the JAMA Internal Medicine reported on the increased risk of chronic kidney disease in users of proton pump inhibitors. “Study findings suggest that up to 70% of these prescriptions are without indication and that 25% of long-term PPI users could discontinue therapy without developing symptoms. Indeed, there are already calls for the reduction of unnecessary use of PPI’s.” This is the conclusion of study authors Benjamin Lazarus, MBBS, from the Department of Epidemiology, Johns Hopkins University, Baltimore, Maryland, and the Department of Medicine, Royal Brisbane and Women’s Hospital, Brisbane, Australia, and colleagues.

The concerns about PPI and the relationship of these drugs to kidney failure and kidney disease has been further examined in a study, recently released in the Journal of the American Society of Nephrology. Researchers looked at 173,321 people in the Veterans Administration system who used PPI’s and 20,270 individuals who took a PPI alternative known as histamine H2 receptor blockers, over a 5-year period. And what they found was a 96% increased risk of developing kidney failure and a 28% increased risk of chronic kidney disease.

In February 2016, the JAMA Neurology journal featured a study conducted by German researchers, who tracked 73,679 men and women over the age of 75 who were taking PPIs.  “After controlling for age, sex, depression, diabetes, stroke, heart disease and the use of other medicines, they found that regular use of P.P.I.s increased the risk for dementia in men by 52 percent and in women by 42 percent, compared with nonusers.”

Each of these studies highlights the risks of taking PPI’s such as Nexium (generic =esomeprazole magnesium) , Prevacid (generic = lansoprazole) and Prilosec (generic = omeprazole). It is worth noting that the authors of the Veterans Administration study feel that PPI’s are being over-prescribed. There appears to be a significant risk of kidney disease or failure, although the study focused on elderly adults with other medical issues. Researchers noted that the risks of GERD (reflux, heartburn)  and other gastric diseases, being treated by these PPI’s, might well outweigh possible risks of developing kidney disease, heart problems, or dementia.  There is no clear answer to the efficacy of PPI’s for the general population, and, apparently, more research is needed. If you have GERD, for example, and you take one of these proton pump inhibitors you should discuss the risks and benefits with your physician.  He or she may decide the benefits of a PPI outweigh the risks for you.  Hopefully that will be the case  because PPI’s are highly effective at relieving symptoms such as heartburn, although the histamine H2 receptor blockers (e.g., Pepcid or generic famotidine) can work as well, although they are not as long-lasting and if you have severe reflux you may need to take a heavier dose of them, which may also have risks.  Unfortunately, there is no easy answer here, so consult your physician and make an informed decision.

 

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    […] With over 21 million people in the US (the estimate in 2009) taking medications called proton pump inhibiters, or PPI’s, (which include Nexium, Prilosec and Prevacid) new medical studies raise some alarms about the safety of these medications. When I […] Injury Board […]

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    […] With over 21 million people in the US (the estimate in 2009) taking medications called proton pump inhibiters, or PPI’s, (which include Nexium, Prilosec and Prevacid) new medical studies raise some alarms about the safety of these medications. When I […] Injury Board […]