PPI’s and their risks, in perspective, from the ACG President.
The biggest admitted downside of PPI therapy at their introduction was cost. With the advent of over-the-counter and generic PPI’s, cost took a back seat and many more patients were managed on chronic, long-term PPI’s with no real attempt to stop or decrease that therapy. Over the past several years, a number of potential adverse effects of PPI therapy have been suggested by large, observational studies. The current President of the ACG discusses the known and theoretical risks of therapy and advises both caution and continued use when appropriate.
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What are the adverse affects of people who have taken ppi ( off label) for years
Calcium deficiency is the most well recognized risk of PPI therapy, and fracture risk is increased in older patients. Iron levels may be reduced. B12 levels may be reduced. Magnesium levels go down slightly on therapy but usually have less meaningful impact on the body. Certain infections of the bowel (C. difficile) are more common. Certain types of pneumonia are more common. More recent reports suggest that infection by COVID19 is a potential risk of PPI use, and that this risk is dose dependent. The effect of the blood thinner Plavix (clopidogrel) may be reduced. On top of these issues, prior publications have suggested an association between use of PPI’s and heart disease, kidney disease, and even dementia. These are all associations, not cause and effect. Some issues, like heart disease or dementia with PPI use have been studied and felt not to be significant. The risk of kidney injury is still being explored.
For in depth reading, see:
“Reported Side Effects and Complications of Long-term Proton Pump Inhibitor Use” by David A. Johnson and Edward C. Oldfield IV in Clin Gastroenterol Hepatol. 2013;11(5):458-464. http://www.medscape.com/viewarticle/804146
“Association Between Proton Pump Inhibitor Use and Cognitive Function in Women” Paul Lochhead, Kaitlin Hagan, Amit D. Joshi, Hamed Khalili, Long H. Nguyen, Francine Grodstein, Andrew T. Chan. Gastroenterology, 2017
“Proton Pump Inhibitors and Risk of Mild Cognitive Impairment and Dementia” Felicia C. Goldstein PhD Kyle Steenland PhD Liping Zhao MSPH Whitney Wharton PhD Allan I. Levey MD, PhD Ihab Hajjar MD, Msc, J Am Geriatr Soc, 65: 1969-1974. https://onlinelibrary.wiley.com/doi/full/10.1111/jgs.14956
“Dementia, cognitive impairment and proton pump inhibitor therapy: A systematic review” Batchelor, R., Gilmartin, J. F.-M., Kemp, W., Hopper, I., and Liew, D. Journal of Gastroenterology and Hepatology, 32: 1426– 1435. https://onlinelibrary.wiley.com/doi/abs/10.1111/jgh.13750
“Increased Risk of COVID-19 Among Users of Proton Pump Inhibitors” Almario CV, et al. Am J Gastenterol. 2020. https://journals.lww.com/ajg/Documents/AJG-20-1811_R1(PUBLISH%20AS%20WEBPART).pdf