If you have been prescribed a PPI, you should keep taking it as directed by your doctor or speak with your pharmacist for advice. If you have been taking a PPI on a regular basis, stopping immediately may lead to an increase in or worsening of your symptoms. Symptoms can be mild, such as rebound acidity, or can be very serious and potentially life-threatening, such as a bleeding stomach ulcer.
This recent study was observational – it doesn’t prove that taking a PPI directly causes death, it can only show there is an association. The increased risk of death may be real, or may be due to chance – observational studies can’t account for any number of unmeasured factors that might influence the outcome. It is possible that other health, socio-demographic or lifestyle factors, such as poor diet, contributed to the higher risk of death.
The authors did not discuss the possible variation in dosages used. As with many medicines, adverse effects for PPIs are dose related. That is, the higher the dose, the greater the chance of a side effect occurring.
The authors noted in their discussion that although they had done their best to account for what is called ‘indication bias’, they could not rule it out. This occurs when a medicine is more likely to be prescribed in patients who appear to have a more severe form of a condition, or are sicker. This raises the question of whether those who were prescribed PPIs generally had worse overall health and were more likely to develop adverse outcomes than those who were given H2 blockers.
No information was included on cause of death. Several deaths occurred in the first year of the study, and could be due to underlying illnesses or other causes.
The people in the study were mostly older, white, male veterans living in the US, which may limit how results can be generalised to the Australian population. The analysis was based on the number of prescriptions issued, but we do not know how many of them were filled, which PPI brands were prescribed, or what the doses were.
The authors of the study noted that PPI use should be limited to cases and durations for which they are medically indicated (that is, when there is good evidence for their use).
In people who respond well to initial full-dose therapy it may be appropriate to reduce PPIs using a ‘step down’ or gradual approach after their problem is resolved.
Long-term use may be needed to help treat some conditions, and in these cases the benefits outweigh the harms for most patients.
Make sure to keep your doctor, nurse or pharmacist informed if you are taking an over-the-counter acid-suppressing medicine, or any other medicine or supplement that may affect the treatment of your condition.