PPI's: are they safe?
Dr. Jesse P. Houghton is a board-certified gastroenterologist. He was born and raised in New Jersey and has been practicing in Southern Ohio since 2012. He has been in practice for over 13 years. He treats both gastrointestinal as well as liver diseases. He prides himself in carefully listening to his patients and their... more
Did you know?....®
The Proton Pump Inhibitors (PPI’s) are one of the most commonly prescribed medications and are taken by millions of Americans. Examples include Nexium, Prilosec, Protonix, Dexilant, Prevacid, etc. They are both over the counter (usually at half the prescription dose) and prescription. They are used for heartburn symptoms, as well as for diagnoses such as GERD, Peptic Ulcer Disease, Barrett’s esophagus, and others.
Recently, there has been a lot of bad press regarding these medications and possible side effects from their use. Various reported side effects (adverse events) include bone fracture, dementia, kidney problems, increased risk of C. diff, increased risk of gastroenteritis (stomach flu), pneumonia, and low vitamin/mineral levels (magnesium, calcium, iron).
What do we do then with this information?
This is potentially a very long discussion, however, the main ‘take-home’ points here are as follows. Almost ALL of these potential side effects have been shown as Associations only, and Not A Cause and Effect relationship. In other words, virtually none of these studies proved that PPI’s CAUSED any of these conditions, only that they had a possible ASSOCIATION with them. In fact, when other researchers looked more closely at these studies, they often found flaws with them and what we call ‘confounding factors’. For example, perhaps patients at increased risk for dementia also were more likely to have conditions that required a PPI. Make sense?
What do I tell my patients? Basically, if you need a PPI for a legitimate reason, they are still one of the safest medications out there. If you don’t need it, or if your symptoms can be effectively managed with a medication such as Pepcid or Zantac (this is another topic), it’s not a bad idea to try those medications instead (as far as we know, those medications don’t have these potential side effects). Some people have conditions that will require a long term PPI (Barrett’s esophagus, bad reflux esophagitis, bleeding ulcer while on blood thinners). In this case, keep taking your PPI unless your provider advises you not to take it for a legitimate reason. I hope that helps!
