GERD and Proton Pump Inhibitors
Proton pump inhibitors have become one of the most heavily prescribed types of medications in the United States. The names of these medications have become familiar even to people who don’t have reflux. Protonix, Nexium, Dexilant, Aciphex and others have become almost as familiar to folks as Pepsi and Coke.
The fact that they are so ubiquitous leads many patients and doctors to assume that they are harmless. Research in this area is beginning to lead many patients and physicians to re-think this assumption and the risk/benefit of long-term usage of these medications.
To be fair, these medications provide an enormous benefit to many patients. Their ability to block the production of acid in the stomach allows ulcers to heal and greatly reduces the symptoms of gastro-esophageal reflux or GERD. These medications make people feel better and they do not want to stop taking them because GERD symptoms rapidly return when the medications are stopped in about 80% of patients. Despite the fact that the FDA has advised that no more than three 14-day courses be used on any given patient in a one year period most people take them on a daily basis for years. Subsequently we are seeing unanticipated side effects.
Although many of the documented side effects are mild many patients are starting to question the wisdom of long-term use. Recent news has begun to highlight some of the more dramatic risk factors, particularly heightened cardiac risks. Some have suggested the increased risk of heart attack among PPI users is up to 21%.
Proton pump inhibitors may increase heart attack risk.
The New York Times (6/11, Bakalar) “Well” blog reports that research published in PLOS One suggests that “proton pump inhibitors…may increase the risk for heart attack.”
The Washington Post (6/11, Bernstein) “To Your Health” blog reports that “after combing through 16 million electronic records of 2.9 million patients in two separate databases,” investigators “found that people who take the medication to suppress the release of stomach acid are 16 percent to 21 percent more likely to” experience a heart attack. Nicholas J. Leeper, an author of the study, “said the Food and Drug Administration ‘should be aware of these findings,’ but agreed that only a large, prospective clinical study…could establish whether the drugs are actually causing more heart attacks.”
On its website, CBS News (6/11, Seidman) reports, however, that “analysis of patients using another type of antacid drugs called H2 blockers…did not show this increased risk.”
This is a tremendously important issue as PPI’s account for BILLIONS of health care dollars being spent every year just in the USA. They are often being taken in a manner that is contrary to FDA recommendations and they may be putting many patients at risk for problems they may not be aware of. I personally see patients every month who are seeking surgical control of their reflux so that they can avoid the possible consequences of long term PPI use.