Researchers at Washington University in St. Louis have shown that proton pump inhibitors, one of the world's most popular drug classes, may increase the risk of death.
By Laurence Banville
A host of popular heartburn drugs used by millions of patients have been linked to a risk for premature death, according to researchers at Washington University in St. Louis.
PPI Risks Inspire Mortality ResearchThe most common medications prescribed for gastric ulcers and gastroesophageal reflux disease (GERD), proton pump inhibitors work by inactivating a protein that triggers the production of stomach acids. They can be extraordinarily effective, but few experts believe PPI drugs should be used for more than a few weeks at a time. With prolonged use, the drugs' risks appear to multiply out of control.
This is a real problem. Sold under the brand names Nexium, Prevacid and Prilosec, most proton pump inhibitors are now available both by prescription and over-the-counter, allowing patients themselves to choose dosage and scheduling.
Over the last decade, dozens of studies have linked proton pump inhibitors to a host of potential complications, from an increased risk for bone fracture to kidney failure and heart attacks. While researchers are still disputing these disparate findings, the overwhelming weight of medical evidence suggests that proton pump inhibitors are dangerous in some way, at least when used for long periods of time. Faced by this general impression, a group of doctors and public health specialists from Washington University and St. Louis University set out to discover whether or not drugs like Nexium and Prevacid could increase a patient's overall risk for death.
Increased Risk Of Death Is No "Fluke""We started thinking," says study lead author Dr. Ziyad Al-Aly, "if this is really true that PPIs are associated with all of these adverse events, does that translate to a higher risk of death, an increased risk of mortality?" To explore their question, the team used medical records gathered by the US Department of Veterans Affairs, CBS reports. Al-Aly serves as the Associate Chief of Staff for Research and Education at the VA's St. Louis division.
The answer they found, published in the British Medical Journal on June 1, 2017, is troubling. Compared to patients taking H2 antagonists, another form of heartburn drug, people who used PPI drugs were 25% more likely to die after a predetermined follow-up period (median of 5.71 years). A 23% increased risk of death was observed when patients on PPI medications were contrasted with patients who took neither PPI nor H2 antagonists.
Confirming fears first-identified in earlier studies, the risk of a premature death appeared to increase the longer a patient took proton pump inhibitors. According to Dr. Al-Aly, this "graded" relationship is proof that the link between PPI drugs and an early death "is not a fluke. The relationship is there and more robust the longer that patients took their medications." Particular risk elevations were also observed in patients who had not been formally diagnosed with gastrointestinal disorders.
"We Were Startled""The results were very clear," Dr. Al-Aly told CBS. "We were startled by this. However we sliced the data, analyzed it, there was always a consistent relationship between PPI use and risk of death." Increases in risk of 25% or 23% may sound small, but when you consider that more than 100 million prescriptions are written for proton pump inhibitors every year in the United States alone, the danger appears more "significant."
The study's authors make clear that patients currently taking proton pump inhibitors should not discontinue their medication. Even assuming that PPIs are really linked to an increased risk of death, the drugs remain a life-saving treatment for many patients. People using proton pump inhibitors over-the-counter, however, should discuss the risks and benefits with their doctors and follow the drug's labeling instructions.