Proton pump inhibitors (PPIs) are among the most commonly used drugs in the U.S., available in both prescription doses and over-the-counter forms to relieve heartburn. All told, they account for about $10 billion in annual sales.
But all that relief may be coming at a price. In a new study published in the journal BMJ Open, researchers analyzed data from nearly 350,000 people who were prescribed some type of heartburn drug: either a PPI or H2 receptor antagonist, known as H2 blockers. The participants came from the U.S. Veterans Affairs database, and the scientists tracked their health outcomes for up to eight years. The people who were prescribed PPIs (which include esomeprazole, or Nexium, and lansoprazole, or Prevacid) had a 25% higher risk of dying during the study period than those who took the H2 blockers (such as famotidine, or Pepcid, and ranitidine, or Zantac).
In additional analysis, the scientists compared several million people who took PPIs to those who did not take either PPIs or any drugs for heartburn relief; they found that the PPI users had a 15% higher risk of early death compared to non-PPI users and a 23% higher risk of dying during the study than people who didn’t rely on any heartburn relief drugs at all. The findings remained strong even after the researchers accounted for other possible factors that could explain the results, including whether people with heartburn were more likely to have other conditions or be more prone to infections that could affect their death rate.
The results add to growing understanding about the risks of PPIs. While they work on the digestive system to relieve indigestion by neutralizing strong stomach acids, they have been linked to higher risk of pneumonia, kidney problems and even hip fractures since they can inhibit calcium absorption and therefore suppress new bone formation.
But are the risks concerning enough for people who need heartburn relief to stop taking PPIs? The researchers stress that their study does not conclude that the drugs cause early death, only that the medications are linked to premature dying from multiple causes. Still, other studies have recently revealed that drugs like PPIs are commonly overprescribed, and in the current study, the researchers say that much of the added risk may be coming from people who didn’t need the drugs in the first place. People who did not have a digestive issue but used the PPIs were among those with the highest risk of early death.
That means that both doctors and patients should be more critical when prescribing and taking the medications. Lifestyle changes, like diet and exercise, can go a long way toward relieving some cases of heartburn. Avoiding carbonated caffeinated drinks and foods that can cause reflux—such as fatty, spicy and acidic foods—along with eating smaller meals and not lying down after eating, can all help. If you do need a PPI, the researchers recommend using the drugs as a temporary form of relief, not as a permanent solution to indigestion.
The drugs are effective, they say, and may even help many elderly people reduce the bleeding risks linked to aspirin. But they need to be taken in the right doses for the right amount of time to ensure their benefits outweigh their risks.