06 July 2017

Medications for heartburn and the risk of death

Anna Stavina, XX2 century, based on Medical Xpress: Popular heartburn drugs linked to higher death risk


Millions of patients worldwide are taking proton pump inhibitors (PPIs). Doctors often prescribe them for the treatment of heartburn, stomach ulcers and other gastrointestinal diseases. Previous studies have shown that taking PPIs is associated with problems such as kidney damage, bone fractures and dementia. And now scientists at the Washington University School of Medicine in St. Louis have demonstrated that long-term use of these drugs is associated with an increased risk of death.

The researchers analyzed the medical records of more than 275 thousand people who took PPIs, and almost 75 thousand people who received drugs of another class – H2-histamine receptor blockers, to reduce stomach acidity. The results of the study were published on July 3 on the website of the journal BMJ Open (Xie et al., Risk of death among users of Proton Pump Inhibitors: a longitudinal observational cohort study of United States veterans).

"We analyzed the data many times, and we constantly got the same result: taking PPIs increases the risk of death," said the head of the study, Dr. Ziyad Al-Ali (Ziyad Al-Aly). – For example, when we compared patients taking H2-histamine receptor blockers with those who took PPIs for a year or two, we found that those taking PPIs had a 50% higher risk of dying in the next five years. People think that PPIs are harmless because they are freely available, but taking these drugs is dangerous, especially for a long time."

Both PPIs and H2-histamine receptor blockers are prescribed for serious problems such as bleeding from the upper gastrointestinal tract, gastrointestinal reflux and esophageal cancer. Over-the-counter PPIs are often used for heartburn and indigestion.

PPIs have become one of the most commonly used types of drugs in the United States, for example, more than 15 million prescriptions were written monthly for Nexium alone (one of the drugs in this group) in 2015.

A nephrologist by profession, Dr. Al-Ali has previously published studies linking PPIs with kidney diseases, and other scientists have shown a link with other diseases. Al-Ali, the author of the idea, Yan Xie, a data processing specialist, and their colleagues came to the conclusion that, since each of these side effects slightly increases the risk of death, together they can have an impact on the mortality rate of those using PPIs.

The researchers examined millions of veterans' medical records in a database maintained by the U.S. Department of Veterans Affairs (U.S. Department of Veterans Affairs). Scientists found 275,933 people who were prescribed PPIs, and 73,355 people who were prescribed H2 blockers. All selected appointments occurred between October 2006 and September 2008. The researchers then calculated how many patients died and when over the next five years. The causes of death were not specified in the database.

Al-Ali and colleagues found that in the group of patients taking PPIs, the risk of death was on average 25% higher than in the group receiving H2 blockers. The researchers calculated that for every 500 people a year who took PPIs, there is one death that could not have happened. As millions of patients take PPIs daily, this number grows to thousands of extra deaths per year, Al-Ali noted.

The researchers also calculated the risk of death for those who were prescribed PPIs or H2 blockers, despite the fact that they did not suffer from gastrointestinal diseases. It turned out that in the PPIs group, the risk of death was increased by 24% compared to the group taking H2 blockers. The risk became higher the longer people took the drugs. 30 days after the start of administration, the risk of death in both groups differed slightly, but after two years, the risk of death in the PPIs group was higher than that in the H2 group by almost 50 percent.

Despite the fact that the recommended duration of treatment for PPIs is quite short (for example, from two to eight weeks for stomach ulcers), many continue to take the drug for months or even years.

Al-Ali explains: "PPIs are often prescribed because there is a serious reason for this. But then doctors do not stop the prescription, and patients continue and continue to receive the medicine. It is necessary to check from time to time whether the patient still needs this drug. As a rule, there is no need to take PPIs for years."

Compared with the group taking H2 blockers, older people were in the PPIs group (their average age was 64 years, and in the H2 group – 61 years), and their health was slightly worse (diabetes, hypertension and cardiovascular diseases were more common). But these differences cannot fully explain the increased risk of death, since the difference remained statistically significant even after the researchers introduced statistical adjustments for age and health status.

Over-the-counter PPIs use the same chemical components as prescription ones, only in smaller doses. It is also impossible to say exactly how long people have been taking such drugs. The Food and Drug Administration recommends taking over-the-counter PPIs for no more than four weeks, and then be sure to see a doctor.

Dr. Al-Ali emphasizes that in order to make a decision whether to take PPIs or not, it is extremely important to carefully weigh the risk and possible benefits.

Portal "Eternal youth" http://vechnayamolodost.ru  06.07.2017

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