Proton Pump Inhibitors: Dangers of the Most Frequently Prescribed Medicine

The use of proton pump inhibitors (PPIs) has been increasing over the last 20 years. In fact, they are becoming the most frequently prescribed medications in the United States. Some common names for over-the-counter PPIs are Prilosec, Nexium, and Prevacid. 

What are proton pump inhibitors used for?

PPIs are used to treat different issues such as stomach ulcers, acid reflux, heartburn, and erosive esophagitis. Depending on the illness being treated, they are only supposed to be used for two to eight weeks. 

Long-term use has been shown to be quite dangerous. There is a strong link between misuse of PPIs and the development of pneumonia, Clostridium difficile (C. Diff), fractures related to osteoporosis, development or progression of chronic kidney disease and decreased absorption of some vitamins and minerals. Some studies even relate PPI overuse to the development of dementia.

How are proton pump inhibitor users at higher risk for illness?

The purpose of a proton pump inhibitor is to prevent stomach acid from releasing into the stomach. If you have GERD or (acid reflux), then taking a PPI will help relieve symptoms by preventing heartburn. This is great and usually pretty safe if used infrequently. Unfortunately, daily long-term use will begin to change the gut microflora and allow bad bacteria to form. These bad bacteria can prevent the good bacteria from doing their crucial job of protecting the body. 

C. Diff is one of the dangerous bacteria that can overpopulate with PPI overuse. It is common in a hospital or long-term care setting. It causes inflammation of the colon resulting in diarrhea, nausea, and fever. This change in the microflora allows these spores to grow and thrive in the stomach. Similarly, the overgrowth of unwanted bacteria can lead to bacteria growing in the windpipe, which can result in pneumonia.

Vitamin deficiencies associated with PPI use

Vitamin B12: Vitamin B12 is an essential vitamin that cannot be produced by the body and must come from food. It is used to make DNA and help keep the brain, nerves, and blood cells healthy. If someone does not have enough B12, they can become anemic and have neurological difficulties. What is necessary to absorb B12 in the blood? You guessed it- stomach acid. Without stomach acid (from overusing PPIs), B12 cannot detach from proteins and cannot be absorbed by the body. This puts someone at greater risk for Vitamin B12 deficiency.

Vitamin C: Vitamin C is also only available through our diet. Vitamin C has numerous functions in the body, strengthening the immune system, healing wounds, collagen production, and more. The decrease of stomach acid affects the absorption of vitamin C. This can cause dry skin, painful joints, bruising, scurvy, and slower wound healing.

Other vitamins and minerals that can be affected by the long-term use of PPIs include calcium, iron, and magnesium. All of these are vital for a properly functioning body. If you or someone you know has any of these signs and symptoms of PPI overuse, speak with a medical professional as soon as possible.

 Adapted from Therapeutic Advances in Drug Safety