Users of proton pump inhibitors (PPIs), a common type of acid reflux medication, are more likely to die compared with users of similar treatments.
A new study, published today in the medical journal BMJ Open examined medical data from 275,000 PPI users and compared them with people using a different kind of gastroesophageal reflux disease (GERD) medication known as an H2 blocker (sold under names such as Pepcid, Tagamet, and Zantac).
Studies released last year linked PPIs to serious side effects, including dementia and kidney damage.
The drugs are sold under a variety of names including Nexium, Prilosec, and Prevacid. Some are available over the counter.
“The big picture is that [PPIs] are associated with a number of adverse events, and we show in this study that they are associated with increased risk of death,” senior author Dr. Ziyad Al-Aly, a nephrologist at the Veterans Affairs St. Louis Health Care System, told Healthline.
More effective but at a price
PPIs and H2 blockers both work to reduce the production of stomach acid, but the drugs use different biological mechanisms.
H2 blockers are effective for some conditions, such as peptic ulcers. PPIs have largely proven to be more effective in treating GERD.
That effectiveness comes at a cost.
“When we compared patients taking H2 blockers with those taking PPIs for one to two years, we found those on PPIs had a 50 percent increased risk of dying over the next five years,” Al-Aly said in a press release.
“People have the idea that PPIs are very safe because they are readily available, but there are real risks to taking these drugs, particularly for long periods of time.”
GERD is quite common
Caring for GERD symptoms has become big business.
Al-Aly’s research indicates that use of prescription PPI usage has doubled from 3.9 percent to 7.8 percent in the U.S. adult population since 1999.
According to statistics compiled by Healthline, 60 percent of the adult population will experience some kind of GERD symptoms within a year. From 20 to 30 percent will have weekly symptoms.
An estimated 64 million prescriptions for GERD medications, including PPIs and H2 blockers, are written in the United States annually.
Researchers calculate that the increased mortality risk among PPI users leads to one extra death per every 500 users annually.
With millions of users in the United States taking the drug, there is a potential for thousands of related deaths every year.
Prescribed when not needed
Despite the prevalence of PPIs, Al-Aly and his team write that it is often — between 53 percent and 69 percent of the time — prescribed for inappropriate indications.
Over-prescribing or continued prescriptions appear to be a large part of the problem.
“A lot of times people get prescribed PPIs for a good medical reason, but then doctors don’t stop it, and patients just keep getting refill after refill after refill,” Al-Aly said in a statement.
“Most of the time, people aren't going to need to be on PPIs for a year or two or three.”
Mild cases of heartburn most likely do not need to be treated with a PPI. Antacids such as Tums, Rolaids, or the myriad of generics will most likely suffice.
Indigestion and heartburn can also often be ameliorated through lifestyle and diet changes, such as eating smaller meals and lowering alcohol consumption.
Reasons why it’s still a mystery
The research did not explain why PPIs cause a higher risk of mortality for its users.
They hypothesize that the most plausible reason would be the drug’s numerous adverse effects, particularly dementia, kidney disease, and low magnesium levels (hypomagnesemia).
Al-Aly suggests that people using PPIs that are interested in lowering or stopping their prescription should speak with their physician.
“This class of drugs should only be used when medically indicated and for the shortest duration possible,” he said.