Are Heartburn Drugs Bad for Your Health?
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Are Heartburn Drugs Bad for Your Health?

They relieve acid reflux fast—but could cause problems down the road.

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By Amy Capetta

Proton pump inhibitors (PPIs) are widely used medicines that relieve heartburn by reducing stomach acid production—and for that purpose, they're pretty darn effective. “It is probably one of the most popular drugs prescribed worldwide for treatment of heartburn and gastroesophageal reflux (GERD), and it has been around since 1989,” says Rudolph A. Bedford, MD, a gastroenterologist at Southern California Medical Gastroenterology Group in Santa Monica, California. The medicine is also available over the counter, under brand names including Prilosec and Nexium.

Dr. Bedford further explains that while some patients, like those who have been diagnosed with a peptic ulcer, might be on this medicine temporarily—usually for a couple of months—those who suffer from chronic heartburn could be on it indefinitely, even for years. Unfortunately, long-term use of PPIs has been linked to several potentially dangerous conditions. Here, we highlight five.

Clostridium difficile

2 / 6 Clostridium difficile

Prior studies have shown that ongoing PPI use was associated with an initial episode of Clostridium difficile (C diff) infection, causing inflammation of the colon, known as colitis. This condition causes frequent watery diarrhea, possibly along with abdominal pain and fever. Medical researchers from McGill University in Montreal later discovered that continuous use of PPIs also increased the likelihood of a recurrence.

“Having the gastric pH [acidity] elevated may cause an overgrowth of this bacteria, especially in our elderly patients,” says Bedford. These findings, which were published in a 2015 edition of JAMA Internal Medicine, suggest that physicians should consider taking patients off the medication if/when they're first diagnosed with Clostridium difficile.

Heart disease

3 / 6 Heart disease

Some lab research suggests that chronic use of PPIs may speed up the aging process that takes place in the cells that line the inside of the blood vessels. The end result: a possible increased risk of heart attack and renal failure.

"These drugs do not seem to adversely affect the heart and blood vessels when taken for a few weeks,” stated lead researcher John Cooke, MD, PhD, in a 2016 release about the study that he started over five years ago at the Houston Methodist Research Institute. “However, we urgently need studies to assess the impact of long-term use on vascular health in a broad patient population.”

Dementia

4 / 6 Dementia

After analyzing the data of 73,679 adults 75 years of age or older, researchers from the German Center for Neurodegenerative Diseases in Bonn, Germany, found that 29,510 of them had developed dementia—and those who regularly took PPIs had a 44 percent increased risk of memory loss compared to those who were not prescribed PPIs.

“The present study can only provide a statistical association between PPI use and risk of dementia,” wrote the researchers. “The possible underlying causal biological mechanism has to be explored in future studies.”

“They hypothesize that the PPIs somehow cross into certain portions of the brain cells and affect the brain, but it hasn’t been proven,” emphasizes Bedford.

Kidney disease

5 / 6 Kidney disease

In November 2016, two studies presented at the annual meeting of the American Society of Nephrology highlighted the possible damaging effects PPIs (as well as H2 blockers, another common medicine for heartburn, acid reflux and ulcers) may have on the kidneys.

The first study included roughly 187,000 participants who did not have kidney stones. In a follow-up of up to 12 years, taking PPIs was associated with a 12 percent higher risk of developing a kidney stone. Use of PPIs was also associated with lower urinary excretion of calcium, oxalate, citrate and magnesium, which are components of kidney stones. In a follow-up of up to 26 years, those who took H2 blockers were at a 13 percent higher risk of developing kidney stones.

The second study was comprised of 152,157 patients taking PPIs or H2 blockers. PPI use was associated with a greater than 30 percent higher risk of developing chronic kidney disease or kidney failure, or more than a 50 percent decline in one measure of kidney function.

“They have been seeing patients with more kidney injury in patients taking PPIs, but these are observational studies,” says Bedford. “It’s been observed, but there’s not really firm data proving it.” 

Premature Death

6 / 6 Premature Death

Here’s a scary thought: Extended use (meaning months or years) of PPIs has been associated with an early demise. That was the finding in a 2017 study from the Washington University School of Medicine published in the journal BMJ Open.

After examining the data of 275,000 adults who take the drug to reduce stomach acid, those who took it for one to two years were shown to have a 50 percent increased risk of dying within five years, compared to patients who took H2 blockers. Overall, the medical researchers calculated that older adults who take PPIs had a 15 percent increased risk of mortality.

Ziyad Al-Aly, MD, an assistant professor of medicine and senior study author, explained in a released statement that PPIs save lives. “If I needed a PPI, I absolutely would take it,” he said. “But I wouldn’t take it willy-nilly if I didn’t need it. And I would want my doctor to be monitoring me carefully and take me off it the moment it was no longer needed.”