Proton Pump Inhibitors

Proton pump inhibitor (PPI) is a class of drug that reduces the production of stomach acid. They are prescribed or recommended in over-the-counter (OTC) form to patients with acid reflux, ulcers, and other conditions involving excess stomach acid. PPIs can have very serious side effects, especially with long-term use which can cause nutritional deficiencies due to malabsorption leading to complications such as serious kidney disease and bone fracture.

Proton Pump Inhibitors and Their Uses

PPIs are available in prescription and OTC form. Examples of PPI drugs include:

  • Prilosec (omeprazole)
  • Prevacid (lansoprazole)
  • Nexium (esomeprazole)
  • AcipHex (rabeprazole)
  • Protonix (pantoprazole)
  • Dexilant (dexlansoprazole)

PPI uses include:

  • Relieving symptoms of gastroesophageal reflux disease (GERD), also known as acid reflux
  • Healing damage to the esophagus caused by GERD
  • Heal peptic ulcers
  • Eradication of H. pylori when used in combination of antibiotics
  • Treatment of Barrett’s esophagus

Proton Pump Inhibitor Side Effects

Common PPI side effects include:

  • Headache
  • Rash
  • Nausea
  • Diarrhea
  • Constipation
  • Abdominal pain
  • Flatulence

Long term use of PPI drugs is discouraged because reduced stomach acid can cause malabsorption, leading to nutritional deficiencies, and compromises the immune system. But, discontinuing PPIs can be difficult for many patients because of the rebound in acid levels. PPIs can cause malabsorption of calcium, magnesium, B12, and iron.

PPI use has been associated with increased risk of:

  • Heart attack
  • Pneumonia
  • Clostridium difficile infection
  • Hip, wrist, and spinal fractures
  • Kidney problems
  • Dementia

Kidney Problems Linked to Proton Pump Inhibitors

Recent studies have found an increased rate of kidney disease in PPI users.

A study published in JAMA Internal Medicine, in January, 2016, found that PPI use was associated with a 20% to 50% higher risk of chronic kidney disease. The study followed 10,482 people for an average of 13.9 years. It compared PPI users to people who used histamine 2 receptor antagonists (H2 blockers) and to people who did not use heartburn medications.

Another study, published in the Journal of the American Society of Nephrology, in April, 2016, found an increased risk of developing new chronic kidney disease, progression of kidney disease, and kidney failure.

This study looked at Veterans Administration databases, identifying 173,321 new PPI users and 20,270 new H2 blocker users. Over the course of five years, the PPI users had a 28% greater risk of developing chronic kidney disease and twice the risk of end-stage kidney failure as compared to H2 blocker users. Researchers also found that longer use of PPIs increased the risk with those using PPIs for one to three years being three times as likely to experience kidney failure than those using PPIs for one month or less.

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