Heartburn Medicines: Not As Benign As You Think?

How many of you take a daily pill for chronic heartburn? Many Americans are bombarded with TV ads showing “the purple pills” such as Prilosec and Protonix, a couple of which are now OTC. These once-a-day stomach acid-suppressing proton pump inhibitors (“PPI” for short; generic names omeprazole, lansoprazole and other –azoles) really do work very well for acid reflux and heartburn, but many people mistakenly take these chronically instead of the recommended 2-4 weeks. Taking these continuously, without mentioning this to your doctor, can sometimes mask a more serious stomach disease. Also, there’s some accumulating evidence of more concerning problems with long-term use. One recent study published in the Annals of Internal Medicine found an increase in c dificile infections in the gut when people took PPI medicines long-term (Proton Pump Inhibitor Use Linked to Clostridium Difficile Infection). C dificile is an increasingly common, very contagious cause of severe diarrhea, especially in hospital patients. One quote from the editor:

“The increases in the risk of Clostridium difficile infection with PPIs are not at all modest, reflecting the likely importance of gastric acid in protecting against infection from this pathogen,” Dr. Katz writes.

“A pharmacoepidemiologic study of more than 1,000,000 hospital discharges in this issue of the Archives demonstrates a dose-response curve between level of acid suppression and C difficile infection…. Another article in this issue extends this association by demonstrating that the use of PPIs during treatment for C difficileinfection was associated with a 42% increase in the rate of C difficile recurrence.”

Another recent study, this time in JAMA, noted an increase in hip fractures in people over 50 who were on a PPI for at least a year. This issue of bone fractures and PPIs has been reported before; the evidence is still not conclusive at all, and it may be more an association than a causation, but doctors are becoming more concerned about this data.

Bottom Line?

The bottom line is that very few people should be taking PPIs chronically, and far too many people are wasting their money doing just that. If you’re taking it chronically, you may have something more serious than your typical acid reflux — and you also may be putting yourself at risk of more infections and maybe fractures.

You can read more about PPIs on multiple consumer websites, including this one from Consumer Reports, as well as more scholarly research from UptoDate Patient Information.

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