Do PPIs Have Serious Side Effects?
As you are probably aware, there has been a lot of discussion of a possible link between proton pump inhibitors (PPIs) and possible side effects like chronic kidney disease, reduced bone density and dementia.
PPIs are a class of medications widely used to treat chronic heartburn and ulcers of the stomach and small intestine. These medicines are available both over the counter and by prescription from your physician.
Much of our recent heightened concern has been due to a German study which showed an increased number of elderly patients (75 or older) who were taking PPIs had developed dementia as opposed to those who were not taking these medications.
The German study, like others before it, was based on a retrospective review (a study in which investigators are “looking back” at information that had been collected about patients in the past). Sometimes these types of studies involve the review of thousands of medical charts and sometimes they involve the review of previously collected information from an altogether different study.
For example, a recent article suggesting a link between kidney disease and PPI therapy was derived from data from an atherosclerosis (vascular disease) study. Regardless, this type of data is not generally considered to be of “high quality” because it is very difficult to control for other factors that might have affected the eventual outcomes that were being studied.
Like other studies involving PPI therapy, it is important to note that the German study only showed a possible association, not a cause-and-effect link between the two. It also did not account for a variety of other risk factors such as body weight, diet and lifestyle and the impact that these might have had on the risk for BOTH reflux and dementia.
Similarly, reviews of patients with chronic kidney disease suggest a possible association with PPI use but often patients with kidney disease have high blood pressure, higher body weights, and diabetes; all of which are often found amongst heartburn patients as well.
No study to date has shown definitive evidence to support a cause-and-effect relationship between long term PPI use and an increased risk of dementia, osteoporosis or chronic kidney disease.
Should You Be Concerned?
Experts agree that much more research is needed on the topic to answer these questions. Randomized clinical trials will be necessary to prove these and other claims regarding PPIs.
In this type of trial, patients will be followed going FORWARD in time with attempts to better control for other factors that might confuse the results. If you are currently taking PPIs and are concerned, talk to your doctor.
As with ANY medication, using the lowest effective dose is always wise. Similarly, if a medication is not needed then it should not be used or it should be substituted for a less potent medication. It is important to understand the risks associated with long-term PPI use, but it is just as important to know the effects of not treating chronic acid reflux.
The link between PPI use and the potential side effects remains uncertain after almost fifteen years of review of available data. Given what we know at this time, the risks of PPI use are likely to be outweighed by the numerous benefits of this family of medications.