Study raises concerns over commonly used stomach tablets

A recent study on PPI’s (Proton Pump Inhibitors) has reported an increased risk of death, which was stronger with prolonged use. These are very commonly prescribed medications and are even available over-the-counter. Understandably this research has received much interest on social media, so let’s clarify the issues.

What are these stomach medications?

PPI’s are medications to reduce the production of acid in the stomach. They are important for treating stomach ulcers, reflux (gastro-oesophageal reflux GORD/ ‘heartburn’) and related conditions. They are generally considered quite harmless. As with any medication some possible side-effects have been reported with varying evidence including osteoporosis, low magnesium and kidney troubles but these are quite rare.

Before PPI’s were used, another class of medication known as ‘H2 Antagonists’ were used for these conditions. H2 Antagonists also reduce stomach acid but are less powerful and need to be taken twice daily instead of once.

What did the research actually show?

The research examined medical records of hundreds of thousands of predominantly older white male US military veterans who were commenced on PPIs or H2 Antagonists and compared the two medications to each other and against no medication. It was well conducted research using complex statistical methods to analyse the results. To (over-)simplify the results, it seems PPI users were at an approximately 20 per cent increased risk of death compared to H2 Antagonist users or those not on any medication. The risk of death increased with time. The cause of death was not studied.

What are the limitations of this research?

While this sounds like a large increase in risk, it’s helpful to keep in mind that the overall risk is still very low. This is because the rate of death attributable to PPIs is very low, so increasing this low risk by 20 per cent is still a very low number.

Although, this is well conducted research, it is an ‘observational’ study meaning the researchers looked back at data that was already collected. While the results seem convincing, observational research can’t prove cause and effect. To prove a link ‘prospective’ studies are required where participants are enrolled before commencement of medication and ‘randomised’ to which treatment they receive and then followed over time.

As the participants in this study were mostly older white US military veterans it’s also worth considering whether the results of this study are generalisable to the broader community.

In summary, while it’s a good study with a potentially important result, the overall risk is low and further research is still required.

So, what does this mean for me if I take PPI’s?

Please discuss this with your GP next time you renew your script. It’s good practice for your doctor to re-consider the need for any medication every six months when script renewals are done.

PPIs are important medications that serve a useful purpose and will continue to do so. However, as with all medication it’s important they are not over-used.

If you take PPIs long-term for a minor reason, your doctor might suggest having a break from medication to see if you still need it. Consideration could be given to using the medication ‘as required’ rather than every day to reduce the overall amount you take. Some people’s symptoms may be controlled with H2 antagonists rather than PPI’s.

You could reduce your need for medication by reducing the amount caffeine, alcohol, spicy foods and ‘NSAID’ (non-steroidal anti-inflammatory) medication you use, also by eating slowly and mindfully.