Proton pump inhibitors should not be used for longer than necessary, study finds

Research compares death rates of people taking PPIs with those taking H2 blockers  

Proton pump inhibitors (PPIs) are a group of drugs whose main action is a pronounced and long-lasting reduction of stomach acid production. They are prescribed for prevention and treatment of acid-related conditions, such as heartburn and stomach ulcers. PPIs are widely used either as prescription or over-the-counter drugs.

Several previous studies have suggested that taking PPIs is associated with serious adverse events, including cardiovascular disease (CVD), acute kidney injury, chronic kidney disease (CKD), dementia, pneumonia, gastric cancer, Clostridium difficile infections and osteoporotic fractures.

• RELATED: Acid reflux treatment drugs linked to heightened risk of premature death

PPIs are often taken without proper medical indications and for much longer than needed so it is important to know how safe these drugs are.

New users identified

In this longitudinal study, researchers compared death rates of those taking PPIs, such as omeprazole, with those taking H2 blockers, such as cimetidine, which reduce acid by blocking histamine receptors. They identified new users of acid suppression drugs and followed them for ten years to examine associations between PPI use and cause of death. The researchers found that using PPIs is associated with increased mortality from CVD and CKD.

• RELATED: Drugs used to treat acid reflux increase stomach cancer risk

This adds to the body of evidence showing that PPI use carries risk. The researchers are clear that, for some people, there are medical benefits to using prescribed PPIs, but they should only be used where the benefits outweigh the risks and should not be used for longer than necessary.

Reference

• Xie Y, Bowe B, Yan Y et al (2019) Estimates of all cause mortality and cause specific mortality associated with proton pump inhibitors among US veterans: cohort study. BMJ. 365:l1580. doi: 10.1136/bmj.l1580

Ruth Sander is an independent consultant in the care of older people