July 2016

It is estimated that one in 14 Americans currently uses proton pump inhibitors (PPIs) to help control acid reflux disease. Past studies have shown that long-term use of PPIs may increase the risk of dementia, renal failure and cardiovascular disease in some patients. A recent study in Circulation Research provides some clues as to the mechanism of the injury on the cardiovascular system.

According to Nadeem Hussain, M.D., a gastroenterologist at Middlesex Hospital, “In general, PPI medications are currently often overused and over prescribed. Not realizing the health risks of long-term use, patients have been asked to continue on the antacid medications. Some patients do require tight control of gastric acid and, in these special cases, continued use may be required. Given this new information, the medical community will need to be more judicious with the use of this class of medications.”

Dr. Hussain explains that the most recent research indicates that the prolonged use of PPIs may affect the lining of blood vessels, causing build-up and “aging” of these vessels. He adds that the mechanism of injury to the cell lining in the blood vessels is just recently being understood. Also, it’s currently not known whether one PPI is any safer than another.

Additional harmful effects of PPI therapy include predisposing one to developing serious infections such as C-difficile infection or pneumonia by allowing specific bacteria to overgrow within the upper and lower gastrointestinal (GI) tract, thereby also resulting in lung infections in some patients.

Also, by tight control of gastric acid, nutrients may not be well absorbed further in the GI tract. Nutrients affected could include magnesium, calcium, Vitamin D, Vitamin B12, and iron. Bone strength may also be affected and the risks of fractures may be increased by long-term use.

Dr. Hussain advises that patients who have been on PPI medications for more than 1-2 months may want to discuss the need to continue the therapy with their health care provider. He or she can help determine if the benefits of the medication outweigh the risks, or if alternative treatments are available. There are a number of other antacid therapies that do not cause similar harmful effects.

He concludes, “If the PPI medications need to be continued, I would recommend using the lowest dose possible, whenever possible, with the hope of minimizing the chance of side effects over the long term.”

The information contained within is not meant to substitute for the advice of your physician.