Acid-reducing drugs, also known as proton pump inhibitors (PPIs), are one of the most successful drug classes ever to hit the market, projected to generate revenue of up to $3.26 billion in 2026.
“Twenty-five years after their introduction into clinical practice, PPIs remain the mainstay in the treatment of acid-related diseases,” states the study, published in the journal BMC Medical. “Overall, PPIs are irreplaceable drugs in the treatment of acid-related diseases.”
PPIs, which include both prescription and over-the-counter preparations, are used to treat acidic conditions such as gastroesophageal reflux disease, or GERD (which results from stomach acid repeatedly flowing back up the esophagus), as well as other conditions such as heartburn, stomach upset, and the risk of gastrointestinal Bleeding in the intestines in patients with ulcers or those using blood thinners such as aspirin. More than 15 million Americans have been prescribed PPIs, and many others buy the drugs over the counter.
But despite their popularity, questions about the drug class remain. According to a 2018 study published in the Journal of Neurogastroenterology and Motility, “PPIs are typically given for conditions where the need for the drug is unclear,” opening the door to such side effects, albeit rare, as:
- Allergic reaction
- Collagenous colitis
- kidney damage
- Liver damage/infection of abdominal fluid
- lung infection
- gastrointestinal infection
- gastric tumors
- Stomach inflammation/ulcers
- gastric polyps
- colon cancer
- Bacterial overgrowth of the gut
- Decreased absorption of nutrients
The risk of dementia from PPIs drew attention in 2016 when an observational study by German researchers was published in JAMA Neurology. It linked regular use of PPIs to a 44 percent increased risk of dementia compared to people not taking the drugs.
The study was based on the medical records of 73,679 people aged 75 and older.
Research published in the journal Expert Review of Clinical Pharmacology explains and complements the potential PPI risks:
“The risk of pneumonia [from PPI use] was increased by 27-39 percent with short-term PPI use in three meta-analyses,” the researchers wrote. “C. difficile infections [a serious intestinal parasite] have also been linked to PPI use,” as have thrombocytopenia (low platelet count), rhabdomyolysis (muscle damage and breakdown), and nephritis (inflammation of the kidneys).
Research published in Current Gastroenterology Reports reflects the risk of vitamin and mineral deficiencies cited in the Journal of Neurogastroenterology and Motility.
The US Food and Drug Administration (FDA) is aware of the risks that increase with long-term use. According to US Pharmacist, “Since 2010, the FDA has issued various safety warnings regarding the possible effects of long-term use of PPIs,” not only the adverse events listed by the Journal of Neurogastroenterology and Motility, but also PPI-related risks such as fractures, Clostridium difficile-associated diarrhea, and lupus -related events.
“Although proton pump inhibitors (PPIs) remain the primary treatment for GERD, they do not cure the disorder and can leave patients with persistent symptoms despite treatment,” adds Physician’s Weekly. Patients are also not immune to other conditions, the publication states, noting that “patients are still at risk of developing complications such as peptic strictures, Barrett’s metaplasia, and esophageal cancer.”
Because the class of drugs is intended to be used as briefly as possible, the journal Gastroenterology warns that “patients with uncomplicated GERD who respond to short-term PPIs should subsequently attempt to stop or reduce them. Patients unable to reduce PPI should consider ambulatory esophageal pH/impedance monitoring [measuring the amount of acidic and non-acidic reflux in the esophagus during a 24-hour period] before committing to lifetime PPIs to differentiate GERD from a functional syndrome.”
A drug class with strengths and weaknesses
Acid-related conditions certainly occur, e.g. B. when excess acid occurs in the wrong place, and are uncomfortable. Such events are “a threat that inflames and irritates the esophagus, typically causing heartburn and sometimes contributing to the development of ulcers in the stomach and duodenum, the first part of the small intestine,” explains Harvard Health.
And yet the potential long-term side effects uncovered by researchers and public health officials raise questions about whether the drugs are being overprescribed.
“Taking a PPI is useful if you have, or have the prospect of developing, a chronic problem with stomach acid,” says Harvard Health. “But the occasional case of mild heartburn doesn’t need to be treated with a PPI. For this type of on-site use, the old-school antacid medicines like Tums, Rolaids and Maalox will most likely work just as well.”
Cedars-Sinai, a nonprofit academic health organization, advises that taking an acid blocker doesn’t fix other causes of GERD, such as “obesity, overeating, caffeine and alcohol, and eating chocolate and spicy foods.”
And there’s another potential side effect of PPIs, according to US pharmacists: hypergastrinemia.
“This condition causes rebound hyperacidity; After stopping PPI therapy, patients may experience worsening of GERD symptoms,” the publication reads. “To avoid this, PPIs should be gradually phased out. In addition, hypergastrinemia can cause parietal cells to hypertrophy and enterochromaffin-like cells (ECL) [gastric secreting cells] undergo hyperplasia.”
PPI related to COVID-19 contagion
Because our stomach acid protects us from many viruses and bacteria, some people, particularly in the medical field, were not too surprised when PPIs were linked to a higher risk of contracting COVID-19 early in the pandemic.
In 2020, the American Journal of Gastroenterology published a study by researchers affiliated with Cedars-Sinai Medical Center and Michigan Medicine who discussed the link.
“In a nationwide study of people with a history of gastrointestinal symptoms, we found that PPI use was associated with increased chances of reporting a positive COVID-19 test. People who take PPIs twice a day — a common off-label practice in both primary and secondary care — are at highest risk because they are nearly four times more likely to develop COVID-19 compared to people who don’t take PPIs. Report 19 positivity.”
dr Brennan Spiegel, one of the researchers and guarantors of the study (a research author who is responsible for the integrity of the entire work), told Time, “Viruses like SARS-CoV-2 are capable of rapidly closing the gastrointestinal tract hijack … It can efficiently invade, replicate, and proliferate. There’s even a theory that it might use the gut as a home base of sorts, where it nests and then spreads throughout the body.”
The following year, Gut magazine reported on related research. In a cohort of more than 100,000 PPI users, non-users, and former users, the PPIs were not associated with a higher risk of getting COVID-19, but PPI users experienced “a 79 percent higher risk of serious clinical consequences from COVID -19 19,” the magazine reads. While the potential risks of PPIs were recognized well before COVID-19, the pandemic has clearly contributed to questions.
Alternatives to PPI
Are There Herbs That Can Help Reduce Stomach Acid? Yes, according to a 2019 study published in the journal Current Gastroenterology Reports.
“With a focus on reflux and non-cardiac chest pain, research is ongoing on the clinical utility and the diverse physiological mechanisms underlying a variety of complementary and alternative modalities,” wrote researchers from Thomas Jefferson University and the University of Pennsylvania.
Complementary and alternative modalities include “diet manipulation, apple cider vinegar, melatonin, acupuncture, and various herbal products (including rikunshito, STW 5, slippery elm, licorice, and peppermint oil)”. While the researchers acknowledge a “substantial gap” between “anecdotal and empirical” knowledge about non-pharmacological cures for acid diseases, they also call possibilities for future research “compelling.”
Finally, Johns Hopkins Medicine reminds people to stay away from certain foods that have been linked to an acid reaction, such as:
- Fried Food
- Fast food
- Potato chips and other processed snack foods
- Chili powder and pepper (white, black, cayenne)
- Fatty meats like bacon and sausage
- Tomato based sauces
- citrus fruits
- Carbonated Beverages