Update on PPIs: Risk Versus Benefit

More than 15.9 million adults in the U.S. suffer from digestive diseases, reports the Centers for Disease Control and Prevention (CDC). Gastroesophageal reflux disorder (GERD) makes up a portion of this group. Those with GERD often experience severe symptoms of acid reflux and many turn to proton pump inhibitors (PPIs) to reduce symptoms.

PPIs have gained notoriety over recent years as the definitive solution to GERD and complications of acid reflux. In fact, many PPIs such as Nexium, Prevacid and Prilosec, have become available over-the-counter. PPIs appeared to be another step in the goal of better community health. However, new information suggests otherwise and patients and caregivers need to understand how this information impacts quality of care.


Proton-Pump Inhibitors (PPIs) Increase Risk for Kidney Disease:

PPIs have always contained a list of contraindications. “Prolonged use of PPIs have been linked to [malnutrition} and loss of bone density previously,” asserts MedlinePlus. A new five-year study of PPI and non-PPI users, reports CBS News indicates the risk may be much higher than previously thought.

Unlike most medication studies the referenced study relied on outside information collected by the Department of Veterans Affairs. Researchers analyzed information from approximately 200,000 patients to determine results. Approximately 170,000 individuals began taking PPIs during the analyzed period. Meanwhile, 20,000 individuals began taking an alternative to PPIs known as histamine H2 receptor blockers (H2-blockers).

The most pertinent findings of the study include the following:

  • 15% of those on PPIs developed chronic kidney disease.
  • 11% of those on H2-blockers developed chronic kidney disease.

Unfortunately, this raw data didn’t consider other factors. Upon such consideration, researchers found the risk of developing chronic kidney disease while taking PPIs rose 28%.


Findings Affect Wide Range of Population:

Statistics from the CDC fail to reveal the true impact of GERD or acid reflux. Since the CDC doesn’t mandate reporting of these disorders, prevalence estimates are compiled from self-reporting. According to Healthline, “60% of adults will experience GERD within a 12-month period.” Moreover, one-third of those individuals will experience symptoms on a weekly basis, reasserting the need to understand how drastically the new findings may impact the population.

These findings could also be applied hypothetically to those with existing risk factors for acid reflux. Understanding the epidemiology of a disorder or disease relies on careful analysis of how certain conditions contribute to the development of other diseases. This is the cornerstone of improving community health: more information equals reduced risk and rate of diagnoses.

Risk factors for acid reflux, explains the Mayo Clinic, include the following:

  • Hiatal hernia
  • Pregnancy
  • Dry mouth
  • Asthma
  • Diabetes and metabolic disorders, such as cirrhosis of the liver or kidney disease
  • Delayed peristalsis
  • Connective tissue disorders
  • Obesity


Information May Be Insufficient to Warrant Action.

Researchers and officials at the Food and Drug Administration are hesitant to implement drastic changes to dosing recommendations for PPIs. In 2015, PPIs were linked to a slightly increased risk for heart attack yet the information never entered mainstream media. Part of the problem is that both the previous conclusion and the conclusion of the more recent study on PPIs do not show a direct causal-relationship.

In the current study, researchers attempted to isolate variables to determine the exact relationship. They were unsuccessful. For example, researchers accounted for an increased median age of PPI users. Yet, the relationship only showed a correlation, not cause-and-effect.

Regardless of relationship, the most drastic problem, end-stage kidney disease, only occurred in less than 0.2% of PPI users. Furthermore, the study group only makes up approximately 10.4% of those with GERD or acid reflux. Consequently, assumptions about changes in PPI recommendations should not be made yet.


KD Risks Continue Without PPI Use.

Ignoring information about medications that could increase risk for kidney disease contradicts the principles of better community health and quality of care. However, conclusions must be made on a scientific basis, and the risks of developing kidney disease closely mimic the risks of developingGERD or acid reflux.

Risk factors for kidney disease include metabolic disorders, diabetes, hypertension, heart disease, and a family history of kidney disease, emphasizes the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDKD).

Each of these risk factors has something in common: they allude to poor lifestyle choices. For example, obesity may contribute to each factor and obesity can be influenced by family choices. Ultimately, the risk of developing kidney disease continues even without PPI use. So, what does this mean for those currently taking or considering taking PPIs?


Final Thoughts on Discontinuing PPIs.

PPIs are powerful medications that reduce the action of acid-producing cells in the lining of the stomach. These medications can effectively eliminate the recurrence of acid reflux, allowing the esophagus to heal.

As society has become more focused on prevention, attitudes toward long-term use of PPIs have changed. PPIs are intended for short-term use to manage acid reflux but many continue to usePPIs beyond these recommendations. In cases where PPIs are prescribed by a physician discontinuation should only take place if recommended by the provider. Some PPI users may benefit from transitioning to an H2-blocker, virtually eliminating the increased risk for kidney disease.

An over-the-counter status for a medication doesn’t mean the medication is risk-free. Rather than turning a blind eye to risk, community health programs need to increase focus on lifestyle remedies for acid reflux and education about how to properly use PPIs. This is the only logical conclusion until more evidence is gathered.

Jason Vanover

Working in health care since 2005, Jason's body of experience encompasses dozens of care settings, including Senior care, psychiatric facilities, nonprofit health service centers, group homes for those with developmental disabilities and beyond. Jason understands the need to tailor his skills to each setting to encourage the best treatment outcomes and promote an inclusive, healing environment.

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