Antacid medications (PPI's) associated with increase risk of osteoarthritis, chest pain, urinary tract infections -- along with pneumonia -- and also  cancer, diabetes and stroke

Gastric cancer

Cancer of the lower esophagus is called adenocarcinoma and is caused by GERD. Its frequency is increasing at an alarming rate, faster than any solid tumor ever measured. In fact, this frequency has increased 600 percent in the US and 800 percent in Europe since 1975!

Why is this happening? there is evidence to suggest that the increased use of powerful acid suppressing drugs to treat reflux symptoms may be contributing.

These  powerful acid suppressing medications are in a class of drugs called PPIs. They decrease the acid production in the stomach but have no effect on the reflux. The reflux continues with stomach contents bathing the lower esophagus. PPI's increase Gastrin and this may increase cancer risk. PPI's do not cure or decrease the reflux. They just cover it up and decrease symptoms. Cancers continue to develop. It is even thought possible that as these drugs become more powerful, they further “activate” the cancer-causing chemicals providing further explanation for the increasing cancers.

If you have GERD, you should be concerned about it causing cancer. You might even be concerned about taking PPIs and allowing the reflux to continue.(the above information is from the Minnesota Reflux & Heartburn Center https://www.mnheartburn.org/the-cancer-risk/ )

 

PPIs stimulate the production of gastrin, which is a potent growth factor, and Gastrin also has been shown to play an important role in the stimulation of growth of several gastrointestinal cancers including gastric cancer (Cell Mol Gastroenterol Hepatol. 2017 Jul; 4(1): 75–83.)

 

Proton pump inhibitors

PPI's act by irreversibly blocking the hydrogen/potassium adenosine triphosphatase enzymesystem (the H+/K+ ATPase, or, more commonly, the gastric proton pump) of the gastric parietal cells. The proton pump is the last stage in gastric acid secretion, being directly responsible for secreting H+ ions into the gastric lumen, making it an ideal target for reducing acid secretion.

 PPI's can reduce gastric acid secretion by up to 99%. However, stomach acids are needed to digest proteins, vitamin B12, calcium, and other nutrients, and too little stomach acid causes the condition hypochlorhydria. as well as associated the the following conditions including cancer.

Long-term use of drugs PPI's to curb acid reflux linked to doubling in stomach cancer risk

 

Researchers compared the use of PPIs with another type of drug used to dampen down acid production called histamine H2 receptor antagonists (H2 blockers) in 63,397 adults treated with triple therapy -- a combination of a PPI and two antibiotics to kill off H pylori over 7 days -- between 2003 and 2012.

They were subsequently monitored until they either developed stomach cancer, died, or the study ended (end of December 2015), whichever came first. The average monitoring period lasted 7.5 years.

During this time, 3271 (5%) people took PPIs for an average of nearly three years; and 21,729 took H2 blockers.

In all, 153 (0.24%) people developed stomach cancer after triple therapy. None tested positive for H pylori at the time, but all had long standing gastritis (inflammation of the stomach lining).

Taking PPIs was associated with a more than doubling (2.44) in the risk of developing stomach cancer, while taking H2 blockers was not associated with any such heightened risk.

The average time between triple therapy and the development of stomach cancer was just under 5 years.

More frequent use was associated with greater risk, with daily use linked to a more than quadrupling in risk (4.55) compared with weekly use.

And the longer PPIs were used, the greater was the risk of developing stomach cancer, rising to 5-fold after more than a year, to more than 6-fold after two or more years, and to more than 8-fold after three or more years.

This is an observational study, so no firm conclusions can be drawn about cause and effect, and PPIs are generally considered safe, say the researchers.

But recent research has linked their long term use to various unwanted effects, including pneumonia, heart attack, and bone fracture, they point out, adding that PPIs are known to stimulate the production of gastrin, a powerful growth factor.

The "clear dose-response and time response trend" in the use of PPIs and stomach cancer risk, prompt them to suggest that doctors "should exercise caution when prescribing long-term PPIs...even after successful eradication of H plyori. (Ka Shing Cheung, Esther W Chan, Angel Y S Wong, Lijia Chen, Ian C K Wong, Wai Keung Leung. Long-term proton pump inhibitors and risk of gastric cancer development after treatment forHelicobacter pylori: a population-based study. Gut, 2017)

Esophageal cancer risk higher in medically treated GERD patients with fewest symptoms

All study participants underwent endoscopy and completed questionnaires and a detailed medication history. Endoscopy revealed that 122 of these patients, or 15.9 percent, had Barrett's esophagus or adenocarcinoma. Patients who were adequately managing their GERD symptoms with proton pump inhibitors (PPIs) were 61 percent more likely to have Barrett's esophagus or adenocarcinoma if they reported no severe GERD symptoms, compared to patients taking PPIs who reported severe symptoms. Patients with severe GERD symptoms often experienced irritation or swelling of the esophagus, but that was associated with decreased odds of having esophageal cancer (Katie S. Nason; Promporn Paula Wichienkuer; Omar Awais; Matthew J. Schuchert; James D. Luketich; Robert W. O'Rourke; John G. Hunter; Cynthia D. Morris; Blair A. Jobe. Gastroesophageal Reflux Disease Symptom Severity, Proton Pump Inhibitor Use, and Esophageal Carcinogenesis. Archives of Surgery., 2011)

Proton Pump Inhibitors and Kidney disease

Proton pump inhibitors (PPIs), which are commonly used drugs to reduce acid in the stomach, appear to be associated with an increased risk of chronic kidney disease but more research is needed to determine whether PPI use causes kidney damage, according to an article published online by JAMA Internal Medicine.(Benjamin Lazarus, Yuan Chen, Francis P. Wilson, Yingying Sang, Alex R. Chang, Josef Coresh, Morgan E. Grams. Proton Pump Inhibitor Use and the Risk of Chronic Kidney Disease. JAMA Internal Medicine, 2016)

Kidney Stones and PPI use

Proton pump inhibitors (PPIs) and histamine receptor-2 (H2) blockers are commonly used to reduce gastric acid production. To see if these drugs increase the risk of developing kidney stones, Pietro Manuel Ferraro, MD, MS, PhD (Fondazione Policlinico Universitario A. Gemelli -- Catholic University of the Sacred Heart, in Rome, Italy) and his colleagues examined information on 187,330 participants of the Health Professionals Follow-up Study (HPFS) and Nurses' Health Study (NHS) I and II who were initially free of kidney stones.(American Society of Nephrology (ASN). "Reflux and ulcer medications linked to kidney stones and chronic kidney disease." ScienceDaily. ScienceDaily, 18 November 2016.)

PPI's may icreased risk of dementia by 44 per cent

The study population included 218,493 individuals 75 or older before 144,814 individuals were excluded, leaving 73,679 individuals included in the final analysis. The authors identified 29,510 patients who developed dementia during the study period.

Regular users of PPIs (2,950 patients, mostly female and average age nearly 84) had a 44 percent increased risk of dementia compared with those (70,729 patients, mostly female and average age 83) not receiving PPI medication, according to the results.

  1. Willy Gomm, Klaus von Holt, Friederike Thomé, Karl Broich, Wolfgang Maier, Anne Fink, Gabriele Doblhammer, Britta Haenisch. Association of Proton Pump Inhibitors With Risk of Dementia. JAMA Neurology, 2016

  2. Lewis H. Kuller. Do Proton Pump Inhibitors Increase the Risk of Dementia? JAMA Neurology, 2016)

PPI use may increase risk of stroke

Researchers analyzed the records of 244,679 Danish patients, average age 57, who had an endoscopy -- a procedure used to identify the causes of stomach pain and indigestion. During nearly six years of follow up, 9,489 patients had an ischemic stroke for the first time in their lives. Researchers determined if the stroke occurred while patients were using 1 of 4 PPIs: omeprazole (Prilosec), pantoprazole (Protonix), lansoprazole (Prevacid) and esomeprazole (Nexium).

For ischemic stroke, researchers found:

  • Overall stroke risk increased by 21 percent when patients were taking a PPI.

  • At the lowest doses of the PPIs, there was slight or no increased stroke risk.

  • At the highest dose for these 4 PPI's, stroke risk increased from 30 percent for lansoprazole (Prevacid) to 94 percent for pantoprazole (Protonix).

  • There was no increased risk of stroke associated with another group of acid-reducing medications known as H2 blockers, which include famotidine (Pepcid) and ranitidine (Zantac).(American Heart Association. "Popular heartburn medication may increase ischemic stroke risk." ScienceDaily. ScienceDaily, 15 November 2016) 

Acid suppression medications linked to serious gastrointestinal infections

In a population-based study from Scotland, use of commonly-prescribed acid suppression medications such as proton pump inhibitors (PPIs) was linked with an increased risk of intestinal infections with C. difficile and Campylobacter bacteria, which can cause considerable illness.

 

Compared with individuals in the community who did not take acid suppression medications, those who did had 1.7-times and 3.7-times increased risks of C. difficile and Campylobacter, respectively. Among hospitalized patients, those using the medications had 1.4-times and 4.5-times increased risks, respectively (Li Wei, Lasantha Ratnayake, Gabby Phillips, Chris C. McGuigan, Steve V. Morant, Robert W. Flynn, Isla S. Mackenzie, Thomas M. MacDonald. Acid suppression medications and bacterial gastroenteritis: a population-based cohort study. British Journal of Clinical Pharmacology, 2016)

PPI's associated with increase risk of osteoarthritis, chest pain, urinary tract infections -- along with pneumonia -- and also  cancer, diabetes and stroke

The results showed that patients taking PPIs were more likely than nonusers to have osteoarthritis, chest pain, urinary tract infections -- along with pneumonia -- and also to have been diagnosed or treated for health problems such as cancer, diabetes and stroke. Even during time periods when they did not have PPI prescriptions filled, PPI users had a greater likelihood of having those or other health problems that could not plausibly be caused by taking those drugs (Anupam B. Jena, Eric Sun, Dana P. Goldman. Confounding in the Association of Proton Pump Inhibitor Use With Risk of Community-Acquired Pneumonia. Journal of General Internal Medicine, 2012)

Use Of Acid-suppressive Medications Associated With 30 per cent Increased Risk Of Hospital-acquired Pneumonia

Hospitalized patients who receive acid-suppressive medications such as a proton-pump inhibitor have a 30 percent increased odds of developing pneumonia while in the hospital, according to a new study.

With the introduction of proton-pump inhibitors, used primarily in the treatment of ulcers and gastroesophageal reflux disease, the use of acid-suppressive medications has increased significantly over the last several years, with estimates that between 40 percent and 70 percent of hospitalized patients receive some form of them. But this high use in the inpatient setting has been of concern for several reasons, including use for indications that are not supported by research and data suggesting an increased risk for community-acquired pneumonia with use in outpatient settings, according to background information in the article.

Shoshana J. Herzig, M.D., of Beth Israel Deaconess Medical Center, Boston, and colleagues examined the association between acid-suppressive medication use and hospital-acquired pneumonia. The study included data on patients who were admitted to a large, urban, academic medical center from January 2004 through December 2007, including patients who were at least 18 years of age, hospitalized for 3 or more days, and not admitted to the intensive care unit. Acid-suppressive medication use was defined as any order for a proton-pump inhibitor or histamine2 receptor antagonist. The study included data on 63,878 hospital admissions.

Overall, acid-suppressive medication was ordered in 32,922 admissions (52 percent). Of the group who received these medications, 27,236 (83 percent) received proton-pump inhibitors and 7,548 (23 percent) received histamine2 receptor antagonists, with some exposed to both. The majority of these medications were ordered within 48 hours of admission (89 percent).

Hospital-acquired pneumonia occurred in 2,219 admissions (3.5 percent). The unadjusted incidence of hospital-acquired pneumonia was higher in the group exposed to acid-suppressive medication relative to the unexposed group (4.9 percent vs. 2.0 percent). After further analysis and adjusting for potential factors that could influence the outcomes, receiving acid-suppressive medications was associated with a 30 percent increased odds of hospital-acquired pneumonia. The association was significant for proton-pump inhibitors but not for histamine2 receptor antagonists.

The researchers write that acid-suppressive medications have been thought to increase the risk of pneumonia via modification of upper gastrointestinal bacteria, and, as a result, respiratory bacteria.

"These results occur in the context of an increasing body of literature suggesting an association between acid-suppressive medication and pneumonia. Further scrutiny is warranted regarding inpatient prescribing practices of these medications," the authors conclude.(Herzig et al. Acid-Suppressive Medication Use and the Risk for Hospital-Acquired Pneumonia. JAMA The Journal of the American Medical Association, 2009)

NOTICE; This article is for educational purposes only and is not medical  or treatment advice. Always talk to your healthcare practitioner/doctor about  any treatment and prevention and follow their advice.

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