Americans concerned about their health are reading about potentially dangerous side effects of long-term use of Proton Pump Inhibitors (PPIs), such as links between Prilosec and stomach cancer or Nexium and chronic kidney disease. As a result, many patients are stopping the medications without talking to their doctors, which also could be dangerous.

PPIs are a class of drugs designed to control excess stomach acid. Patients suffering frequent heartburn, acid reflux and gastroesophageal reflux disease (GERD) may experience relief of symptoms after taking a course of PPI treatment. PPI medications are available in over-the-counter and prescription dosages.

The U.S. Food and Drug Administration (FDA) recommends taking PPIs as directed for 14 days to treat frequent heartburn. No more than three 14-day treatments are recommended within a year. Still, patients who are at risk for bleeding ulcers often take PPIs more often. Other patients become dependent upon PPIs rather than change their dietary habits, believing that because the drugs have been available  for more than three decades, they must be safe.

Some of the medications that fall under the class of PPI heartburn meds include:

• Nexium, Nexium IV, Nexium 24 HR
• Prilosec, Prilosec OTC
• Prevacid, Prevacid IV, Prevacid 24-Hour
• Protonix
• Zegerid, Zegerid OTC

Doctors estimate that nearly 70 percent of people currently taking Nexium, Prilosec and other PPIs could actually control heartburn and GERD symptoms with diet.

Prilosec and Stomach Cancer Risk

A recent study has reported a link between PPIs like Prilosec and stomach cancer, among other side effects and complications. A number of heartburn drugs are tied to stomach cancer risks, reports are now warning.

Researchers in the study reported that PPIs double the risk for developing stomach cancer.

According to a 2017 New York Times story, one study suggested a link between heartburn meds, such as Prilosec and Prevacid, and stomach cancer. Although there is an increased risk for developing stomach cancer in those who carry the stomach bacteria known as Helicobacter pylori, even when the bacteria has been eradicated through heartburn meds, stomach cancer may still develop.

Researchers believe the reason for this may be the long-term use of PPI heartburn meds, such as Nexium, Prilosec and Prevacid.

According to the study, 63,397 people were evaluated in Hong Kong for treatment of an H. pylori infection. Of that group, 3,271 people were treated with PPI heartburn meds, and 21,179 were treated with an H2-receptor antagonist, a different kind of antacid medication that works by blocking the production of histamines in the stomach.

Over a span of 7.6 years, 153 people had developed stomach or gastric cancer, the researchers found.

These numbers reflect more than twice the incidence of cancer among those who had been treated with H2 blockers. Controlled factors for the study included controlling for: obesity, statin use, hypertension, alcohol use, and smoking.

The study’s lead author, a professor of medicine at the University of Hong Kong, said that “even after the eradication of H. pylori, the risk of cancer persists with PPIs.” He cautioned that “the absolute risk is not high, and I don’t want to discourage people from taking these drugs when necessary. There are people who benefit tremendously from them.”

Nexium/Prilosec Kidney Side Effects

This is not the first time that PPI heartburn meds have faced criticism over adverse side effects and complications. Prilosec and other heartburn meds have also been linked to kidney problems and kidney failure, according to studies.

And again, studies compared the use of PPIs with that of H2-receptor antagonists, and the results were not favorable to PPIs.

Researchers from the United States and Australia sought to determine the relationship, if any, between proton pump inhibitors and chronic kidney disease, according to the Washington Post, and after analyzing the medical records of more than 10,000 patients receiving community-based treatment, the scientists found that those who had been using PPIs had a more frequent incidence of chronic kidney disease, 20 to 50 percent higher when compared to patients who hadn’t used PPIs.

Researchers also found a similar incidence after analyzing the records of more than 248,000 people treated in a hospital system in Pennsylvania.

Although PPI users often had other health problems such as obesity or diabetes, the researchers said the relationship still appeared even after accounting for those problems.

For comparison, that study looked at the results of treatment with H2-receptor antagonists, which did not reveal the same association with kidney disease that PPIs had.

Further research was recommended to determine whether limiting the use of PPIs could reduce the incidence of chronic kidney disease.

Further Evidence of Link Between PPI and Kidney Disease

The Department of Veterans Affairs conducted a study that determined patients who take Nexium, Prilosec or other PPIs could be up to 96 percent more apt to develop kidney failure and 28 percent more likely to experience chronic kidney disease after using the drugs for five years.

In another study published this year in the Journal of American Medicine, PPI users were shown to have up to a 50 percent greater risk of chronic kidney disease than those who did not take the drugs.

The University of Findlay College of Pharmacy published a study in 2014 that warned of widespread overuse and abuse of PPIs. In addition, many people who take PPIs do so for more than four years.

Chronic kidney disease is a gradual degradation of the kidney’s ability to filter wastes from the blood. It afflicts more than 13 percent of the U.S. population.

Patients with chronic kidney disease are at risk of it progressing into full-blown kidney failure, which opens the door to a whole world of complications. It can lead to anemia, nerve damage, degradation of bone tissue, dangerous increases in blood acidity, and an overall increased risk of death.

Some patients develop cardiovascular problems like heart failure or pericarditis. In most patients, chronic kidney disease continues to get worse despite treatment.

Treatment of kidney disease may require dialysis or a kidney transplant. Untreated kidney disease is fatal.

Potential Link Between PPI Use and Dementia

The German Center for Neurodegenerative Diseases in Bonn, Germany, published a study in February 2016 showing a nexus between PPI use and the onset of dementia.

Researchers are not sure why there is a link, but it is believed that PPIs might cross the blood-brain barrier, allowing the medication to interact with brain enzymes.

There are patients who have taken these medications for 20 years or more who are suffering the consequences of heartburn medication side effects.

Premature Aging of Vascular Cells

The American Heart Association published a study in the online edition of its May 2016 Circulation Research journal. Researchers from the Houston Methodist Research Institute’s Cardiovascular Sciences Department found that extended Nexium use prematurely aged the cells that make up the inner lining of blood vessels, weakening the lining.

Led by John Cooke, M.D., Ph.D., the study looked at possible links between extended use of PPIs and an increased risk of heart attack, renal failure and dementia.

Healthy cells that make up the lining of our blood vessels create a smooth surface that stops blood from sticking to the sides of the blood vessels. Older, damaged cells in the lining become rough and uneven, allowing blood elements to stick and create blockages.

“When we exposed human endothelial cells over a period of time to these PPIs, we observed accelerated aging of the cells,” Cooke said. “The PPIs also reduce acidity in lysosomes of the endothelial cell. The lysosomes are like cellular garbage disposals and need acid to work properly. We observed cellular garbage accumulating in the endothelial cells, which sped up the aging process.”

Cooke believes the artificial aging of the endothelial cells could be the source of the wide range of adverse effects seen in patients who take PPIs for a long period of time, sciencedaily.com reports.

Number of PPI Prescriptions Still Rising

Despite the accumulating evidence of potential harm from overusing PPIs, the number of prescriptions continues to increase. According to a report by Patrick Meek, PharmD, of Albany College of Pharmacy and Health Sciences in New York, the number of prescriptions written during outpatient visits rose from 1.6 percent in 1998 to 7.6 percent in 2015. He presented his data at the National Center for Health Statistics at the Digestive Disease Week 2019 Conference in San Diego in May 2019

Chiemeziem Eke, MD, of Baylor College of Medicine in Houston, also presented at the Digestive Disease Week Conference, and said that reports show 77 percent of overprescribed PPIs originated in an internal medicine, resident-run primary care setting.

Eke said he believes residents are apt to have a “very poor” understanding of PPIs, and he and his colleagues came up with a four-week PPI taper order to help effectively wean patients off PPIs.

Eke suggested in the taper order that the patient decrease the medication to every other day for two weeks, followed by taking it every four days for two weeks. At the end of that period, the prescription could be stopped unless the patient was being treated for certain chronic conditions, such as Barrett’s esophagus or a history of bleeding gastrointestinal ulcer.

Patients who continued to experience occasional gastric discomfort were expected to manage those issues by taking an on-demand antacid, PPI or H2-receptor antagonist. Where appropriate, patients were advised to lose weight, finish eating two or three hours before going to bed, propping up the head of the bed and avoid problematic foods and beverages.

A study of the taper order found a 16 percent drop in PPI prescriptions, and the number that were considered inappropriately prescribed fell from 77 percent to 52 percent. Eke said 65 percent of inappropriate prescriptions were for GERD.

Patients who developed stomach cancer, kidney disease, dementia or other serious ill effects after taking Prilosec, Nexium, Prevacid or other PPI heartburn meds may be eligible to file a PPI lawsuit to pursue compensation for medical bills, pain and suffering, and other damages.