A type of heartburn relief medicine known as proton pump inhibitors, which are readily available over the counter, may be linked to many ailments such as long-term kidney damage. Proton pump inhibitors are used in the treatment of ailments like GERD, peptic ulcers, and h. pylori.
The study, “Proton Pump Inhibitor Use and the Risk of Chronic Kidney Disease,” published in JAMA Internal Medicine, says that proton pump inhibitors (PPIs) are among the most commonly used drugs worldwide and have been linked to acute interstitial nephritis and chronic kidney disease (CKD). However, a direct cause-and-effect relationship between the drug and the disease was not established.
Medications like Prilosec, Nexium, and Prevacid belong to this class of drugs, which treat heartburn and acid reflux by lowering the amount of acid produced by the stomach. According to the Johns Hopkins study, people who intake PPIs have a 20 to 50 percent higher risk of chronic kidney disease compared with nonusers.
John Clarke, a gastroenterologist at Johns Hopkins Hospital in Baltimore, told NPR, “The teaching for many years was that these drugs were quite safe. But there is data that’s emerging that suggests PPIs may not be as safe as we think they are.”
Sold by prescription and over the counter, an estimated 15 million Americans use PPIs. They are known to suppress stomach acid more effectively than a previous class of drugs called H2 blockers like Zantac, Tagamet, and Pepcid.
Stomach acid helps digest food and also acts as barriers against various pathogens, which could be ingested. So when there’s less stomach acid, it leaves people vulnerable to nutritional deficiencies and infections, including food poisoning like salmonella, Clostridium difficile, and perhaps pneumonia. The side effects include low magnesium levels and weak bones and muscles. One recent study published in PLOS suggested people who take PPIs may be at greater risk of heart disease.
Clarke said, “It’s imperative that people who take these drugs look at the risks versus benefits in their individual case and make sure the safety concerns are being looked at closely and people don’t use these drugs lightly.”
Many people take PPIs unnecessarily. Simple lifestyle changes, such as losing weight and cutting back on alcohol, caffeine, and spicy and fatty foods, could get help them in getting rid of their heartburn. PPIs are usually meant to be taken for two to eight weeks, although doctors may recommend more.
The companies that make PPIs say they’re safe for most people if they use them the way they’re supposed to. Doctors say many people really need to take a PPI for severe heartburn.
Kenneth DeVault, a gastroenterologist at the Mayo Clinic who is the president of the American College of Gastroenterology, cautions patients not to panic over news of the study.
He said, “The most important thing is to discuss it with a treating physician and make sure everyone is on the same page and understands the benefits and weighs those against this fairly small, but perhaps real, risk. I think more research on this subject will be important. When you have that many people taking a drug, and there’s a small potential risk, it certainly gets both physicians’ and patients’ attention.”
He added, “Proton pump inhibitors do have some very positive benefits to patients. They relieve symptoms better than any other medication that has ever been developed. The most important positive effect of proton pump inhibitors is restoration of a quality of life. This is probably the big one.”
He states that PPIs may also reduce the risk of esophageal cancer for some people.
DeVault says if someone really needs a PPI, they should take one. But they should try everything else first, keep an eye out for any side effects, and talk to their doctor about how long they should stay on it.
The elderly are more prone to the side effects and risks. Last year, an American Geriatrics Society panel added proton pump inhibitors to the list called the “Beers Criteria for Potentially Inappropriate Medication Use in Older Adults,” citing the risk of bone loss and fractures and C. diff infection. The Food and Drug Administration has also issued several safety announcements about these drugs.
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