Proton pump inhibitors linked to increased death risk

By Dr. Ananya Mandal, MDJul 5 2017

Proton pump inhibitors (PPIs) are one of the commonest agents prescribed for heart burn or acid reflux. These agents are available for purchase over-the-counter making them one of the most commonly used drugs that make around $10 billion in annual sales. PPIs work by reducing the production of the gastric acids in the stomach. There are several known risks associated with PPI use including complete stoppage of gastric acid production, risk of pneumonia, kidney disorders, bone fractures such as hip fractures etc.

A new study that was published in the journal BMJ Open, looked at data from nearly 350,000 persons who were taking heart burn drugs including PPIs or H2 blockers was gathered and analysed. Some of the common PPIs used include esomeprazole, or Nexium, and lansoprazole, or Prevacid. Some of the common H2 blockers used include famotidine, or Pepcid, and ranitidine, or Zantac. The data was obtained from the U.S. Veterans Affairs database and the participants were tracked for eight years when their health related problems were all recorded.

Among those studied, there were 349,312 PPI or H2 blockers users. The next group comparing PPI users with no PPI users included 328,8092 individuals. The group testing PPI users against no PPI and no H2 blockers users included 288,7030 users.

Results revealed that those who were prescribed PPIs had a 25% higher risk of dying during this eight years observation period of the study compared to those who took the H2 blockers. These millions of users of PPIs in addition were compared to a large population of individuals who did not take either PPIs or any other agent for relief of heart burn. This showed that the ones who used PPIs had a 15% higher risk of early death compared to those who did not use them. PPI users had a 23% higher risk of dying compared to those who did not take any medication for heart burn.

Other factors that could have skewed the results were all accounted for. For example smokers and those with heart disease are as such at a higher risk of early death. There were equally proportion of these high risk individuals in both PPI user group and non-PPI user groups. Thus the risk of death could not be attributed to these factors alone. PPIs were definitely found to influence the risk of early deaths. Risk of death associated with PPI use was increased among participants without gastrointestinal conditions. The association of PPIs and deaths among new PPI users was graded – that is increased with increased use.

A more vigilant use of this class of drugs is a prudent course of action, feel the researchers. Lead author, Dr. Ziyad Al-Aly, an assistant professor of medicine at the Washington University School of Medicine assured that there is no reason to panic and the risk is not large. In persons who for example have a bleeding ulcer, the benefit provided by a PPI is unquestionable and much over the risk. So there is no reason why it should not be prescribed to those who need it. However where it is not needed, the risks also rise he pointed out. Other methods such as change in diet, exercise etc. could help reduce acid reflux. PPI use if needed should be a temporary measure rather than a long term one.