Most Americans are familiar with advertisements touting revolutionary pharmaceutical drugs followed by a litany of frightening side effects. Beyond the list of potential side effects, what appears to be a societal push toward “all-natural” could make some even more wary of modern medicine, concoctions that don’t come in an oil or which do not grow from the ground. And even if we believe in the proven power of medicine, unless the pain is unbearable, we may think that the devil we know is better than the one we don’t know, choosing to suffer pain without medicine.
Proton pump inhibitors (PPIs) – drugs like esomeprazole (Nexium), omeprazole (Prilosec), lansoprazole (Prevacid and others), and pantoprazole (Prontonix) – are the most commonly used drugs for treat stomach acid problems. Last month, two new studies questioning the safety of PPIs were published. One, in the newspaper Gastroenterology, reported an increase in the incidence of intestinal infections, but no significant increase in various health problems like the development of dementia or pneumonia. The second study, published in the British Medical Journal, found that in a population of United States veterans, PPIs were associated with a small increase in mortality from cardiovascular disease and chronic kidney disease over the study period.
So, are PPIs safe, or even necessary? Penn researchers say this common medication is safe and valuable, provided it’s taken in the right doses and in the right patients.
What are proton pump inhibitors?
IPPs are not newcomers; since the 1980s, they have been used to treat heartburn, reflux, and acid-related problems. H2 blockers (Pepcid and others) arrived first in pharmacies, but they were “blown out of the water by PPIs,” explains David Metz, MD, professor of gastroenterology and director of the acid-peptic program at Penn Medicine, whose research focuses on PPIs. PPIs directly block the action of proton pumps, enzymes found in the acid-producing cells of the stomach, and literally prevent them from releasing acid into the stomach.
Metz says people should take PPIs as maintenance for one of three reasons: They have some sort of chronic reflux like esophagitis or Barrett’s esophagus that requires daily treatment (not just occasional heartburn), they have a very rare condition in which the body produces too much of it. acid, or they regularly take anti-inflammatories that are not steroids (drugs like Aleve, called NSAIDs, or even aspirin) which increase the risk of stomach ulcers. (Note: Too often, people who take NSAIDs and would benefit from proactive PPIs are not actually prescribed them, says Metz.)
The research
“Most of the fears about the safety of PPIs come from epidemiological studies showing a correlation between PPIs and something else. But these studies don’t necessarily mean that one thing causes the other,” says Metz, adding that the two recent studies are examples. “To my knowledge, there is no published research directly showing that PPIs are the leading cause of health problems, with the exception of true allergies which are very rare,” he says. “Cause” is an important and key word when evaluating this and all research.
Metz notes that when drugs go through approval processes, they must demonstrate that the drug itself actually does what it’s supposed to do and does it effectively. Many side effects seen with medications are just links and are not proven.
But even association studies regarding PPIs have been challenged by other research. For example, fears about a link to dementia in older people taking PPIs began with two studies by the same group of researchers in Germany. However, two other studies involving younger and older people found that taking PPIs actually reduced the risk of dementia – results completely contrary to those found in the German-led research.
“Although several studies have definitively ruled out a dementia risk from PPI use and the situation needs to be monitored, the idea that PPIs cause dementia is not supported by science. Don’t worry, especially if you are under 70,” says James Reynolds, MD, chief of gastroenterology and hepatology and director of the neurogastroenterology and motility program at Penn Medicine.
The medical community considers infections and low bone strength to be risks that may be correlated with PPIs. But even one of Metz’s recent studies suggests that bone health is not a problem. In the study, postmenopausal women who took two different PPIs for 26 weeks had no significant changes in their bone turnover (the body’s natural replacement of old bones with new bones) compared to women who took a placebo.
“As with all medications, there are potential risks,” says Reynolds. “But acid levels that are too high or acid present in places where it shouldn’t be are more serious than just a cause of physical discomfort.” Ignoring the fact that you are taking NSAIDs, have severe and prolonged reflux, or have a disorder that causes high levels of stomach acid means you could be putting yourself at risk for long-term consequences such as ulcers, erosion of the stomach lining, scarring of the esophagus. , bleeding or, in severe cases, esophageal cancer.
The truth is that there is probably a happy medium between enjoying the benefits of a PPI while minimizing the risks. Reynolds urges people to talk to their doctor to determine if they need PPIs, for how long and how often. For example, for occasional heartburn, daily PPIs are probably not appropriate, but intermittent “on-demand” treatment may be suitable.
Better yet, taking PPIs less frequently and even gradually switching to H2 blockers once stomach acid is under control can be a good way to get the benefits while reducing the risks. For Metz, what he calls the first law of medicine comes to mind: “The bottom line is to always aim to give patients the lowest effective dose, no more than they need, to limit potential risks. »
