HEARTBURN PILLS OVERUSED
PROTON Pump Inhibitors (Ppis) help reduce the amount of acid produced by the stomach. Originally intended to help with serious stomach conditions such as gastric and duodenal ulcers, these days they are commonly prescribed for indigestion and heartburn, and to a lesser extent to counter the gastric side- effects of nonsteroidal painkillers such as ibuprofen and naproxen.
The number of prescriptions for these pills — which include omeprazole and lansoprazole — has soared from 29 million in 2007 to more than 59 million last year, making them some of the most frequently prescribed drugs in the Uk.
Ppis were originally licensed to be used for no more than four weeks. however, people stay on them for months or even years.
THE CONCERNS
As PPIS reduce stomach acid, this alters the gut microbiome, allowing harmful bacteria to survive and colonise the gut. One worrying new study by Dr Richard Cunningham, a consultant microbiologist at Derriford hospital, Plymouth, published earlier this year in the Journal of hospital infection, found that taking PPIS increased the risk of antibiotic-resistant infections threefold. These include antibiotic- resistant forms of E.coli and salmonella.
Antibiotic-resistant infections can progress to life-threatening conditions such as sepsis.
‘ some bacteria, such as salmonella, may cause symptoms straightaway, such as a bout of food poisoning,’ says Dr Cunningham. ‘but others, such as E. coli, won’t cause problems immediately living in your gut —then six months later, if they travel to the bladder or get into the bloodstream, they can cause infections which may be hard to treat because the antibiotics won’t work against them. The delay can be fatal for some people.’
These bacteria can also be passed on to people living in the same household.
‘ in the past, we identified travel to south-East Asia or the u.s. as a risk factor for infection with antibiotic- resistant bacteria — and while that is still the case, Ppis are now risk factors too. A lot of prescribers aren’t aware of this.’
Dr Cunningham says that between 5 and 8 per cent of hospital inpatients have already been colonised by antibioticresistant bacteria before they come into hospital.
‘The problem is that if someone does develop an antibioticresistant infection months after starting on PPIS, doctors won’t necessarily make the link between the two,’ he says.
An earlier study also linked PPIS with an increased risk of contracting the hospital superbug Clostridium difficile.
but the risks may go beyond infections. A study published
this year in the journal BmJ Open linked PPis to an increased risk of death from all causes compared with those who took H2 blocker stomach acid drugs (these reduce stomach acid too, but not so dramatically).
an icelandic study published this year suggested that the risk of bone fracture was 30 per cent higher in people taking PPis, possibly because they may affect absorption of vitamin D, magnesium and calcium, which are needed for strong bones.
WHAT IT MEANS FOR YOU
CHECK with your doctor or pharmacist whether you should still be on PPis. Dr Cunningham says PPis are good drugs if they are used for the right patients for the correct amount of time, including patients with gastric ulcers or those on other medication that irritates the stomach.
‘Somehow they have become the default drug for anyone with indigestion or heartburn,’ he says. ‘Really they should be reserved for more serious problems such as gastric ulcers and duodenal ulcers.’
Studies — including one from King’s College London as long ago as 2008 — estimate that between 53 and 69 per cent of PPi prescriptions are inappropriately being given for indigestion and heartburn.
‘my advice would be to ask your gP or pharmacist for a medication review to check whether you still need to be on a PPi,’ says Dr Cunningham.
‘it may be that you can be swapped on to H2 antagonists, which reduce stomach acid but not so drastically.
‘PPis are now available over the counter at a lower dose, so the worry is that people can carry on taking them indefinitely without ever seeing a doctor.’
Dr mike Dixon, a gP in Devon, adds that when people come off PPis they get an excessive production of stomach acid and feel they need to restart them. ‘the problem can be avoided if the dose is reduced gradually rather than stopping overnight,’ he says.