The chances are high that right now, you or someone you know is taking an acid-suppressing drug. Over 20.5 million prescriptions for proton pump inhibitors (PPIs) such as Nexium (esomeprazole), Somac (pantoprazole), Prevacid (lansoprazole) and Prilosec (omeprazole) were filled in Australia in 2014, with esomeprazole alone ranking as the 10th most often-dispensed prescribed drug in Australia in 2015.
Health authorities acknowledge that “Many people are taking PPIs without a clear indication for their use” – a fact that I can confirm; often when I ask clients who are taking PPIs, but don’t have gastroesophageal reflux, erosive esophagitis or peptic ulcer disease (the primary prescribing indications for PPIs) why they are taking them, I’m told something vague like “My doctor told me it might help with my stomach problems.”
Given mounting evidence of the dangers of PPIs, this irrational prescribing is incredibly irresponsible. PPIs have been linked to:
- Development of a range of gastrointestinal symptoms such as bloating (43% of patients prescribed a PPI developed bloating for the first time, after 8 weeks on the drug), irritable bowel syndrome (20% of PPI users developed IBS after 6 months on a PPI) and small intestinal bacterial overgrowth (50% of PPI users),
- 74% higher odds of developing Clostridium difficile infection, which causes severe diarrhoea, and 151% higher odds of recurrent C diff infection;
- 45% higher risk of developing chronic kidney disease, 152% higher risk of acute kidney injury and 200% higher risk of acute interstitial nephritis in patients aged 66 and over;
- 40% higher odds of developing pneumonia;
- Significantly increased risk of bone fractures, in both short term (less than 1 year) and long term (more than 1 year) users, including hip fracture (26% higher risk), spinal fracture (58% higher risk) and fracture at any site (33% higher risk); and
- 83% higher risk of developing vitamin B12 deficiency, which can lead to irreversible damage to the brain and nervous system, in long-term users, which may help to explain a 44% higher risk of developing dementia in PPI users, identified in a German study of people aged over 75.
And as if all that wasn’t bad enough, PPIs have now been linked to a heightened risk of the ultimate adverse drug reaction: death. A study published in BMJ Open in March 2017 tracked millions of US veterans using the Department of Veterans Affairs databases for a median time period of almost 6 years. The researchers found that people taking PPIs had a 23% higher risk of dying than those taking no acid suppressing drugs at all, and a 15% higher risk of dying than people who weren’t taking a PPI (this comparison group included those taking an older class of acid blocking drug, H2 blockers such as cimetidine [Tagamet] and ranitidine [Zantac].). In other words, H2 blockers are less dangerous than PPIs, but it’s better to be taking no acid-suppressing medication at all if you wish to live a long life!
Furthermore, the longer people took a PPI, the higher their risk of death – a ‘dose-response’ relationship which increases the probability that there is a causal link between taking a PPI and dying sooner, rather than the association being due to random chance.
How do PPIs increase the risk of death? The study’s authors acknowledge that no one really knows at present, but point out that test tube studies that show that PPIs increase oxidative stress (cellular ‘rusting’), cause endothelial dysfunction (inability of the cells lining blood vessels to carry out their normal functions), shorten telomeres (the protective ‘cap’ at the end of chromosomes that gets shorter every time a cell divides) and accelerate senescence (the loss of a cell’s power to divide, grown and carry out its normal functions) in human endothelial cells.
A word of warning: withdrawing from PPIs can be tricky. Some patients experience rebound acid hypersecretion when they stop taking the drug, which can lead patients to conclude that they can’t stop taking it. I’ve seen a worrying number of clients with gastroesophageal reflux disease (GORD) in the last few years, who have been on a PPI for years, whereas the recommended duration of treatment for GORD is just 2-6 weeks.
I’ve had good success in weaning people who previously suffered severe rebound acid hypersecretion when they tried to go off their PPI – including children who were prescribed a PPI for infantile reflux – using specific probiotics, nutritional supplements and dietary modification.
