A recent analysis of data from the Department of Veterans Affairs has found that more than 4.5 percent of premature deaths among patients receiving care at VA facilities can be attributed to the use of proton pump inhibitors such as Nexium and Prilosec. The analysis recently appeared in the British Medical Journal.
The study was carried out jointly by researchers affiliated with the DVA and the Washington University School of Medicine in St. Louis, Missouri. They discovered that on average more than 45 deaths out of every 1,000 patients were linked to taking PPIs. The medication was associated with a number of conditions that included cardiovascular disorders, gastrointestinal cancer, infections, parasitic infestation, and disease of the genitourinary tract.
In addition to patients who had medical reasons for taking PPIs (such as Barrett’s Esophagus), these trends were also observed in patients for whom the medications were not indicated. This has been a serious issue among the patient population at large. PPIs are among the most widely-prescribed medications in the world and are commonly available in over-the-counter versions as well.
Proton pump inhibitors are generally prescribed for gastroesophageal reflux disease (GERD), a condition in which stomach contents (including digestive acid) flows upward into the esophagus. This occurs when the lower esophageal sphincter (the valve between the stomach and the esophagus) is weak or not functioning properly. In many cases, this condition can be treated with a change in diet and lifestyle. GERD can also be a complication among patients suffering from hiatal hernia, which can be corrected surgically.
PPIs work by shutting down an organelle found in cells lining the stomach. This organelle, known as the proton pump, is the final stage in the production of stomach acid; a loose metaphor would be the fuel injector of an automotive engine. When PPIs shut down this organelle, the effect is permanent.
There are some patients whose conditions require the use of PPIs. However, medical experts recommend that these medications be used for a limited period of time, not exceeding 12 weeks. This is in accordance with research demonstrating that health risks associated with PPIs increase the longer patients continue to use them.
This is where the dangers lie for most people. PPIs are often prescribed or used for extended periods for relatively minor cases of heartburn in patients whose conditions would be better treated with exercise and modifications of diet. Long-term, permanent reduction in stomach acid production is believed to have a negative effect on beneficial gut flora that thrives in an acidic environment. This can clear the way for harmful bacteria that prefer higher pH levels.
The joint VA-WUSM research team recommends “heightened vigilance in the use of PPI [medications].”