Published: Wed, July 05, 2017
Medical | By Garry George

Heartburn medications linked to increased risk of early death

Heartburn medications linked to increased risk of early death

The scientists, whose work is published in the BMJ Open journal, said they do not know exactly why this might be - and indeed could not prove that the drugs were actually causing the increased risk of death.

That said, Al-Aly pointed out that some patients really do need to take PPIs to deal with medical issues, even long-term. "We don't want to leave people with a scary message".

The researchers examined the medical records of about 275,000 people who used prescription PPIs and almost 74,000 who took H2 blockers.

Short-term use of PPIs - up to 90 days - did not appear to affect death risk, the findings showed.

PPI use has previously been linked to a heightened risk of chronic kidney disease, dementia, C difficile infections and bone fractures in people with brittle bone disease.

The other analyses revealed a similar level of risk between users and non-users of PPIs and between those taking PPIs and those taking no acid suppressant drugs.

Researchers at the Washington University School of Medicine in St. Louis concluded that prolonged use of proton pump inhibitors (PPI), which suppresses the secretion of stomach acid and is found in popular heartburn medications such as Prilosec, Nexium and Prevacid, increased an early risk of death by 25 percent, compared to people who used H2 blockers, another known inhibitor of stomach acid.

Off the back of the new findings, researchers have suggested that the use of PPIs should be restricted.

"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.

Among patients who took the medications for one to two years, those on PPIs had a 50 percent greater death risk during the period.

Given how widely available these drugs are, and the accumulating evidence pointing to links with a range of potentially serious side effects, it may be time to restrict the indications for use and duration of treatment with PPIs, suggest the researchers.

No one is sure why PPIs might cause all these health problems or increase risk of early death, Al-Aly said.

In his study, a team of experienced doctors at academic medical centers made a "more detailed assessment of cognitive function" than the previous research, he said. They say that limited use only when medically necessary is best. For example, people with ulcers are advised to take the drugs for only two to eight weeks.

Al-Aly emphasizes that deciding whether to take a PPI requires a risk-benefit calculation.

And because "studies to demonstrate causal relationships between PPIs and death are not likely", Cohen added, "the challenge to physicians should remain to use medications judiciously and continue to assess the benefit of a medication to a patient over time".

Choosing Wisely Canada's gastroenterology list of Five Things Physicians and Patients Should Question also includes: "Don't maintain long term Proton Pump Inhibitor (PPI) therapy for gastrointestinal symptoms without an attempt to stop/reduce PPI at least once per year in most patients".

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