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Monday 3 July 2017

Heartburn drugs taken by millions may increase risk of early death, study suggests

Heartburn drugs taken by millions could raise the risk of dying early, a large study suggests.

There are more than 50 million prescriptions a year for heartburn drugs in EnglandĀ 
There are more than 50 million prescriptions a year for heartburn drugs in England 
Heartburn drugs taken by millions could raise the risk of dying early, a large study suggests.

The drugs which are known as proton pump inhibitors, or PPIs - have previously been linked to a variety of health problems, including serious kidney damage, bone fractures and dementia.

The NHS issues more than 50 million prescriptions each year for the medication which is used to treat heartburn, ulcers and other gastrointestinal problems, but researchers say it may be time to restrict the use of the tablets.

The drugs also are available over the counter under brand names including Prilosec, Prevacid and Zegerid .

Researchers examined medical records of more than 275,000 PPI users and nearly 75,000 people who took another class of drugs - known as H2 blockers - to reduce stomach acid.

"No matter how we sliced and diced the data from this large data set, we saw the same thing: there's an increased risk of death among PPI users,” said study senior author Doctor Ziyad Al-Aly, an assistant professor of medicine at Washington University School of Medicine in the United States.

"People have the idea that PPIs are very safe because they are readily available, but there are real risks to taking these drugs, particularly for long periods of time.

“If I needed a PPI, I absolutely would take it. But I wouldn't take it willy-nilly if I didn't need it. And I would want my doctor to be monitoring me carefully and take me off it the moment it was no longer needed.”

Both PPIs and H2 blockers are prescribed for serious medical conditions such as upper gastrointestinal tract bleeding, gastroesophageal reflux disease and esophageal cancer.

Over-the-counter PPIs are most often used for heartburn and indigestion.

The researchers found a 25 per cent increased risk of death in the PPI group compared with the H2 blocker group.

They calculated that, for every 500 people taking PPIs for a year, there is one extra death that would not have otherwise occurred.

Given the millions of people take PPIs regularly, Dr Al-aly said this could translate into thousands of excess deaths every year.

Dr Al-Aly said that although the recommended treatment regimen for most PPIs is short - for example, two to eight weeks for ulcers - many people end up taking the drugs for months or years.

"A lot of times people get prescribed PPIs for a good medical reason, but then doctors don't stop it and patients just keep getting refill after refill after refill,” he added.

"There needs to be periodic re-assessments as to whether people need to be on these. Most of the time, people aren't going to need to be on PPIs for a year or two or three."

Dr Al-Aly said over-the-counter PPIs contain the same chemical compounds as in prescription PPIs, just at lower doses, and there is no way to know how long people stay on them.

Previous studies have found that the drugs raise the risk of hip fractures by 35 per cent and a heart attack by 20 per cent. Last year German scientists found the drugs increase the risk of dementia by 44 per cent.

Prof Tim Spector of King’s College London, author of The Diet Myth, who recently showed that people taking PPIs had abnormal gut microbe communities that predisposed them to infections said:

“Doctors are handing these drugs out like sweets. I would say around 50 per cent of people don’t actually need to be on them.

“This is an observational study and on it’s own maybe doesn't mean a lot but when you start adding it to all the other research it starts to add up.

“These drugs were developed before people even thought about what was happening in your gut.”

The study, published in the journal BMJ Open, concluded: “Emerging evidence suggests that PPIs may boost the risk of tissue damage arising from normal cellular processes, known as oxidative stress, as well as the shortening of telomeres, which sit on the end of chromosomes and perform a role similar to the plastic tips on the end of shoelaces."

However the Proprietary Association of Great Britain, which represents firms making over-the-counter drugs, said: "All over-the-counter medicines have been approved by the Medicines and Healthcare Products Regulatory Agency and are rigorously assessed for safety and efficacy.

"Once on the market, their safety is continually monitored in light of any emerging evidence. Those who may be concerned should speak to their GP or pharmacist before taking any medicine."

http://www.telegraph.co.uk/science/2017/07/03/heartburn-drugs-taken-millions-may-increase-risk-early-death/