Stomach acid reducers under scrutiny
A higher risk of death is associated with long-term use of popular stomach acid reducers known as proton pump inhibitors, according to a new study.
The drugs are sold under brand names such as Prilosec, Nexium, Protonix, Zegerid, Aciphex and Dexilant, along with generic versions such as omeprazole, lansoprazole and pantoprazole. Originally available only by prescription, they are increasingly offered over the counter. The study looked at prescription use only.
Each year, an estimated 15 million Americans are prescribed proton pump inhibitors, commonly called PPIs. The figure doesn’t include over-thecounter sales.
Previous studies have indicated that long-term use of PPIs is associated with elevated risks for heart disease, bone fractures and other medical problems.
The new analysis goes further by linking the medications to higher death rates.
Prolonged use of PPIs was associated with a 25 per cent greater risk of death, compared with people taking H2 blockers, another class of acid reducers. H2 blockers are sold under brand names including Pepcid, Tagamet and Zantac, as well as generic names such as famotidine, cimetidine and ranitidine.
In the new study, researchers examined millions of military veterans’ prescription records spanning an average of nearly six years. Their findings were published in the journal BMJ Open. The study can be found at j.mp/acidppi. The senior author was Dr. Ziyad Al-Aly of the U.S. Department of Veterans Affairs’ health system in St. Louis.
Acid reducers treat painful ailments including GERD (gastroesophogeal reflux disease), heartburn and peptic ulcers.
Doctors should prescribe PPIs when there’s a legitimate reason, but only long enough to provide benefits that outweigh the risks, the study’s authors said. The increased mortality associated with PPIs was proportionately connected to their duration of use.
Some makers of proton pump inhibitors said their products are effective and safe when used for the recommended period, which is typically about two weeks per full course of the over-thecounter versions. They didn’t specifically address the issue of patients often taking prescription-level PPIs for much longer periods and at higher doses.
For the new study’s main analysis, the records of 349,312 patients were analyzed. Of those people, 275,977 were prescribed PPIs and 73,335 were prescribed H2 blockers. Between the two groups, the patients who took PPIs showed the 25 per cent higher death rate.
Two secondary comparisons were also made. One found a 15 per cent increased death rate for PPI users compared with patients who didn’t use PPIs but may have taken another kind of acid suppressor (other than H2 blockers). Records from 3,288,092 patients were examined for that comparison. In the other secondary comparison, the death rate was 23 per cent higher among PPI users compared with people who didn’t use any acid suppressor. A total 2,887,070 patient records were examined for that analysis.
The study’s comparisons were observational, so the conclusions aren’t as definitive as a random, placebo-controlled clinical trial.
Another limitation is that the Veterans Affairs patients were “mostly older, white male U.S. veterans,” the report’s authors said, so the results might not apply to a larger population. Also, the study didn’t get information on the causes of death for the targeted patient population.
The newly published findings are consistent with previous studies that showed long-term use of PPIs, but not H2 blockers, is associated with higher rates of disease. These include kidney disease, dementia and infection by the antibiotic-resistant superbug C. difficile.
PPIs block stomach cells from releasing positively charged hydrogen atoms, inhibiting production of stomach acid. H2 blockers stop the action of histamine, which stimulates cells to produce stomach acid.