Heartburn, reflux medication linked to early death

Modesto Morganelli
Luglio 4, 2017

"People have the idea that PPIs are very safe because they are readily available, but there are real risks to taking these drugs, particularly for long periods of time".

Gastroenterologist and Conjoint Professor Anne Duggan at the University of Newcastle's School of Medicine and Public health agrees.

Despite the findings, "there are some patients out there who could benefit from PPIs", Al-Aly says.

"While both PPIs and H2 blockers lower stomach acid, they do so in different ways", Al-Aly says.

Popular heartburn drugs known as proton pump inhibitors may raise the chance of death, new research shows. "We don't want to leave people with a scary message". "If I needed a PPI, I absolutely would take it".

They carried out three comparative analyses: those taking PPIs with those taking another type of drug used to dampen down acid production called histamine H2 receptor antagonists or H2 blockers for short (349, 312 people); users and non-users of PPIs (3,288,092 people); and users of PPIs with people taking neither PPIs nor H2 blockers. Now, a new study from Washington University School of Medicine in St. Louis shows that longtime use of the drugs also is associated with an increased risk of death.

Researchers from Washington University in the United States examined medical records of about 2,75,000 users of proton pump inhibitors (PPI) and 75,000 people who took another class of drugs - known as H2 blockers - to reduce stomach acid. Generally, prescription formulas are taken by patients with severe conditions for long periods, while lower-dose over-the-counter formulas are approved for only short-term use by the US Food and Drug Administration.

The scientists used a large database, combing through medical records from the U.S. Department of Veterans Affairs (which did not reveal the patients' identities) to compare death rates among users of PPIs with people who took H2 blockers, another class of drugs that help reduce stomach acid that can cause conditions such as gastroesophageal reflux.

In his study, a team of experienced doctors at academic medical centers made a "more detailed assessment of cognitive function" than the previous research, he said.

There could also be many other risk factors responsible for the risk of early death, such as being overweight, Prof Duggan acknowledged.

Although far from conclusive, emerging evidence suggests that PPIs may boost the risk of tissue damage arising from normal cellular processes, known as oxidative stress, as well as the shortening of telomeres, which sit on the end of chromosomes and perform a role similar to the plastic tips on the end of shoelaces.

The study concludes that the odds of dying rose the longer people used the drugs. "If there really are all these associations with adverse effects, is it true they could also be associated with a higher risk of death?" he asked.

For those who took them consistently for more than six months the risk of death rose to 31 per cent, and if people took them for more than a year the risk jumped again to 51 per cent. "There needs to be periodic reassessments as to whether people need to be on these".

"A lot of times people get prescribed PPIs for a good medical reason, but then doctors don't stop it and patients just keep getting refill after refill after refill", Al-Aly said.

And because "studies to demonstrate causal relationships between PPIs and death are not likely", Cohen added, "the challenge to physicians should remain to use medications judiciously and continue to assess the benefit of a medication to a patient over time". The research is published online July 3 in the journal BMJ Open.

"However, it is important to note that (proton-pump inhibitor) users in general, including those included in their study, are older and have more diseases", Hajjar wrote in an email.

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