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Proton Pump Inhibitors

Some popular over-the-counter and prescription medications used to ease heartburn, indigestion, and acid reflux may dramatically increase the risk for developing chronic kidney disease, according to a new study from Johns Hopkins University.

Researchers found that patients taking these drugs — known as proton pump inhibitors (PPIs) — were as much as 50 percent more likely than those not using the medications to develop the disease.

The findings, published in the journal JAMA Internal Medicine, are only the latest in a series of studies that have called into question the safety of these drugs. Prior research has linked PPIs to heart attacks, bone fractures, gut infections, magnesium deficiency, and C. difficile infections.

“As a nephrologist, I’ve been worried [about the medications] for some time,” Morgan Grams, MD, an assistant professor of epidemiology at Hopkins’ Bloomberg School of Public health and the study’s coleader, told the Washington Post.

PPIs are popular — an estimated 15 million Americans used them in 2013 — because they can effectively treat some ulcers and severe cases of reflux. They’re among the best-selling classes of drugs in the United States, generating $9.5 billion in sales in 2012, according to IMS Health, which tracks drug sales and marketing. The most popular among them, Nexium, racked up nearly $6 billion in 2012 sales — more than any other prescription medication. Other commonly used PPIs are sold under the brand names Prevacid and Prilosec.

For the study, Grams and her colleagues reviewed the medical records of two groups: 10,482 people in an Artherosclerosis Risk in Communities (ARIC) study and 248,751 patients in Pennsylvania’s Geisinger Health System. They concluded that PPI users were 20 to 50 percent more likely than nonusers to develop chronic kidney disease. They also were more likely to have a higher BMI and take antihypertensive, aspirin, or statin medication, but the link to kidney trouble remained when adjusted for those issues.

The connection did not appear in patients who used non-PPI medications such as Zantac and Pepcid, which fight heartburn by blocking histamine production in the cells lining the stomach.

AstraZeneca, which manufactures Nexium, responded to the study’s findings by releasing a statement claiming that its products “are generally safe and effective when used in accordance with the label. This has been established through human data studies and more than a decade of real world clinical use.”

Grams and her colleagues stressed that their results don’t prove PPIs cause chronic kidney disease and called for additional research to delve further into the connection between their use and the disease.

Meanwhile, University of California, San Francisco physicians Adam Jacob Schoenfeld, MD, and Deborah Grady, MD, MPH, writing in the same issue of JAMA Internal Medicine, suggested doctors use caution when prescribing PPIs to patients at high risk for acute and chronic kidney disease, magnesium deficiency, osteoporotic fractures, and C. difficile infection.

“Given the evidence that PPI use is linked with a number of adverse outcomes,” they wrote, “we recommend that patients and clinicians discuss the potential benefits and risks of PPI treatment, as well as the potential alternative regimens such as histamine H2 receptor antagonists or lifestyle changes, before PPIs are prescribed.”


Natural Ways to Fight Heartburn

Heartburn is a familiar foe. Roughly 50 percent of Americans feel the heat at least once a month, while 20 percent suffer from chronic heartburn or GERD (gastroesophageal reflux disease), experiencing symptoms two or three times a week.

Here are a few natural ways to fight heartburn:

  • Find out the root cause of your heartburn.
  • Chew food thoroughly.
  • Eat smaller meals.
  • Take a digestive enzyme before or with a meal.
  • Limit spicy food intake.

Go Deeper

Are your eating and drinking patterns giving you heartburn? Are over-the-counter medications making it worse?  Find out and fix acid reflux for good.

See “Natural Ways to Fight Heartburn.”

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