A study that came out in April has added to the long list of health dangers that have been attributed to the long-term use of proton pump inhibitors (PPIs).  A Swedish study published in Cancer Epidemiology found a strong association between PPI use and an elevated risk of esophageal cancer – which ironically, is a disease these medications were intended to prevent.

The researchers examined nearly 800,000 medical records of patients in Sweden.  They discovered that the use pf PPIs were implicated in over 5 percent of all esophageal cancer in that country.  Although the disease is rare among all groups studied, it was significantly more prevalent among those taking PPIs over an extended period of time.  They conclude the report with a warning to physicians: “Long term use of PPIs should be addressed with caution.”

The study’s conclusions are in line with a drastic increase in the number of esophageal cancer victims since PPIs were introduced three decades ago.  Between 1988 and 2001, there was a 500 percent rise in cases of esophageal cancer. Although this rate has slowed somewhat, it is still abnormally high compared to what it was prior to the arrival of PPIs. 

Nonetheless, the recent study has drawn criticism. Gastroenterologist Dr. Scott Gabbard of the Cleveland Clinic, a specialist in the treatment of gastroesophageal reflux disease (GERD), told Medscape: “This study demonstrates an association, not a cause and effect. I would be very careful not to state that PPIs cause esophageal cancer based on these data.”  Gabbard adds that many of his patients have become wary of taking PPIs since news about the many serious side effects has been appearing in the media.

Yet another criticism of the study is its failure to account for co-morbidities such as obesity, alcohol consumption, and tobacco use – all of which contribute to GERD, itself a risk factor for esophageal cancer.

Nonetheless, the Swedish study confirms earlier research that has discovered links between long-term/excessive use of PPIs and cancer.  One such study, appearing in the July 2011 issue of Annals of Surgery, found “significantly higher odds” of developing esophageal cancer among patients who regularly used PPI’s to control their GERD symptoms. 

More recently, a scientific review and meta-analysis published in January 2017 found no evidence that PPIs were effective in preventing esophageal cancer in patients suffering from “Barrett’s Esophagus,” a condition in which cells making up the esophageal lining are transformed into tissues similar to that of the intestinal lining after repeated exposure to digestive acid.  Another study from that year linked PPIs to a 100% increase in stomach cancer risk.

People who use PPI’s only on rare occasions or for a limited time are not necessarily in danger.  However, when taken continuously over the long-term, the health consequences can be dire, ranging from depression and premature aging to kidney disease and dementia. Now, research has added cancer to that lengthy list. Patients should ask their doctors about alternatives if they are diagnosed with a gastrointestinal disorder that cannot readily be treated with dietary and lifestyle choices.

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K.J. McElrath is a former history and social studies teacher who has long maintained a keen interest in legal and social issues. In addition to writing for The Ring of Fire, he is the author of two published novels: Tamanous Cooley, a darkly comic environmental twist on Dante's Inferno, and The Missionary's Wife, a story of the conflict between human nature and fundamentalist religious dogma. When not engaged in journalistic or literary pursuits, K.J. works as an entertainer and film composer.