Published: Wed, July 05, 2017
Medicine | By Daryl Nelson

Some heartburn drugs linked with increased risk of death

Some heartburn drugs linked with increased risk of death

Participants in the new study from Washington University School of Medicine in St. Louis who took proton pump inhibitors (PPIs) emerged with a more pronounced risk of dying over the study period than people who had another kind of heartburn drug and those who didn't take heartburn drugs at all.

The risk of death was also heightened among those who were taking PPIs despite having no appropriate medical indication for their use, such as ulcers, H pylori infection, Barrett's oesophagus (pre-cancerous changes to the food pipe) and gullet (oesophageal) cancer.

However, concerns about the drugs' safety have been growing in recent years, as studies have linked PPIs to kidney disease, heart disease, pneumonia, bone fractures and dementia.

According to the researchers, theirs was an observational study and did not establish a cause-and-effect. The center's volunteer statisticians noted that up to 10% of people taking proton-pump inhibitors died within one year, which suggests that the deaths may be linked to their' other conditions.

Al-Aly and his co-authors "asked the simple question: Does that translate to increased risk of death?"

The study found that people taking PPIs for a year or more had a 51 percent increased risk of premature death, compared with 31 percent for people on the drugs for six months to a year, and 17 percent for three- to six-month users.

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"They are often overprescribed, rarely deprescribed and frequently started inappropriately during a hospital stay, and their use extended for long-term duration without appropriate medical indication", the authors wrote.

Acid reflux is commonly caused by smoking, obesity and diet.

"People have the idea that PPIs are very safe because they are readily available, but there are real risks to taking these drugs, particularly for long periods of time", Al-Aly said.

"No matter how we sliced and diced the data from this large data set, we saw the same thing: There's an increased risk of death among PPI users", said senior author and assistant professor of medicine Dr. Ziyad Al-Aly in a statement. The longer the use, the higher the risk, he says. Nor were the researchers able to obtain information on the causes of death. Once reviewed, any drug deemed unnecessary by a doctor should no longer be used by a patient. After 30 days, the risk of death in the PPI and H2 blocker groups was not significantly different, but among people taking the drugs for one to two years, the risk to PPI users was almost 50 percent higher than that of H2 blocker users. "Any use beyond casual use should be under the supervision of a doctor", he says.

If about 500 patients took proton-pump inhibitors for a year, there would be one death that may be related to the drug use, explained Al-Aly. "There needs to be periodic reassessments as to whether people need to be on these. If you need this drug and you're under guidance of a doctor, you should continue to take your medication until otherwise advised".

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".

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