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Overuse of acid reducing medications could cause more harm than good

Kathleen Blanchard's picture

Acid reducing medications known as proton pump inhibitors are used by many patients to suppress heartburn. Studies show there are no benefits for taking higher doses of the medications used to treat ulcers. Overuse of the medications used to treat dyspepsia and GERD can lead to more harm than good.

A series of studies highlights the inappropriate use of acid reducing medications, finding that overuse could harm patients. Medications used to treat heartburn by many consumers, and sold over the counter, carry risks. Experts are suggesting new clinical guidelines for prescribing the drugs to protect patients from adverse events associated with inappropriate and overuse of proton pump inhibitors.

Examples of the acid reducing medicines include omeprazole (Prilosec), Prevacid, Aciphex, Nexium and Protonix. The medications reduce the amount of acid produced in the stomach by blocking gastric enzymes. Overproduction of stomach acid causes heartburn, can lead ulcers that can bleed and cause life threatening problems. GERD is also linked to cancer of the esophagus. Physicians routinely prescribe proton pump inhibitors, but used daily the acid reducing drugs can increase risk of fractures in postmenopausal women and lead to infection.

Mitchell H. Katz, M.D., of the San Francisco Department of Public Health, in an editorial accompanying the reports published in the Archives of Internal Medicine writes, "A staggering 113.4 million prescriptions for proton pump inhibitors are filled each year, making this class of drugs, at $13.9 billion in sales, the third highest seller in the United States. These medications effectively treat inflammation of the esophagus, gastroesophageal reflux disease (GERD), ulcers and several other conditions, but evidence suggests that between 53 percent and 69 percent of proton pump inhibitor prescriptions are for inappropriate indications.”

Dr. Katz suggests that clinicians consider the risks and benefits of acid reducing medications before prescribing, adding "That proton pump inhibitors relieve dyspepsia is without question, but at what cost (and I do not mean financial)?”

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A study conducted by Shelly L. Gray, Pharm.D., M.S., of University of Washington, Seattle, and colleagues that included 161,806 women between ages 50 and 79 in the Women's Health Initiative Study, found an overall modest increased risk of forearm, wrist, and overall fractures in women in an eight year study, associated with taking proton pump inhibitors.

The risk of infection from Clostridium difficile was found to increase 74 percent in patients taking acid reducing medication. The bacteria causes diarrhea and inflammation of the colon that can be life threatening. Medications used to treat the infection are costly and often have to be taken for extended periods of time and is highly contagious. The study comes from Michael D. Howell, M.D., M.P.H., of Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, and colleagues in an analysis of more than 100,000 patients discharged from the hospital, conducted over a five year period.

Some physicians prescribe high dose proton pump inhibitors (PPI's) for patients with bleeding ulcers, often mandating approval from insurance carriers to justify the higher doses. A study conducted by Chih-Hung Wang, M.D., and colleagues at National Taiwan University Hospital and National Taiwan University College of Medicine that included 1157 patients showed no benefit for recurrence of bleeding compared to patients receiving normal dosing of the acid reducing medications.

The articles highlighting the risks from inappropriate use and overprescribing of acid reducing medication known as proton pump inhibitors is part of series that focuses on delivering too much in the way of health care to patients, titled, "Less Is More."

The authors write, “Evidence suggests that providing excessive health care service is most likely to occur in situations in which there is not strong evidence to document the benefit and harms of the service." The hope is to develop awareness that overuse of certain healthcare activities can cause more harm than good.

Physician prescribing of proton pump inhibitors decreased from 27 percent to 16 percent, and prescriptions at discharge decreased from 16 percent to 10 percent following initiation of guidelines at one facility, reports Patrick S. Yachimski, M.D., M.P.H., and colleagues at Massachusetts General Hospital and Harvard Medical School, Boston. Overuse of acid reducing drugs could cause more harm that good, and the authors recommend that physicians evaluate the risk of drugs used to treat GERD when treating patients.

JAMA and Archives



P.S. While not making light of people who suffer with GERD, and with alternative health being outside my area of expertise, I have found from personal experience that, counter-intuitively enough, a little dollop of apple cider vinegar does wonders for me if I have indigestion.
Thanks for sharing the results and implications of these studies! Hopefully the findings serve as a wake-up call to a lot of people who take these "mainstream medications" without thinking twice. I work with a Naturopathic Doctor and Digestive Care Expert named Brenda Watson who has some great, natural solutions to reflux. She weighs in on the study findings and gives additional suggestions on her blog.