Proton Pump Inhibitor drugs (PPIs) greatly reduce the production of acid in the stomach. They revolutionized and improved the treatment of ulcers in the stomach and duodenum. When I started medical practice in 1981, I saw many patients who had required stomach surgery to treat their ulcers. Remember the good ol’ Billroth procedures? Of course you don’t. The first PPI approved for use in the US. was cimetidine (Tagamet) in 1979.
But wait, you say. “Isn’t there a reason we have stomach acid in the first place?” Good question! Because if we reduce stomach acid, it may cause problems. Regardless of what acid contributes to food digestion, it also kills germs in food and water. Germs that may kill us if ignored. Most of us in the developed world would be horrified to drink untreated water out of a lake, stream, river, or spring. But what do you think Homo sapiens did for most our 200,000 years of our existence?
Omeprazole was made over the counter in 2003 but I don’t think these drugs should ever have been made available without prescription. PPIs are powerful drugs that treat heartburn by reducing gastric acid production. This is accomplished by PPI binding to the hydrogen/potassium ATPase enzyme on gastric parietal cells lining the stomach. PPIs do more than block acid. They are associated with an increased risk of congestive heart failure, kidney disease, long bone fractures, and dementia, vitamin B12 deficiency, reviewed here. Regular use of proton pump inhibitors is associated with increased incidence of type two diabetes, about 24% higher compared to non-users of the drug. Proton pump inhibitors are also linked an with increased risk of small intestinal bacterial overgrowth (which is a clue as to why these drugs can be harmful). They also increase the risk of infection by Clostridiales difficile by about 2x.
Most of these individual observational studies are unable to establish causation, but the preponderance of evidence points to PPIs causing harm.
Dr Alcock also found evidence that PPI users who catch COVID-19 have 1.6x increased risk for severe disease and death.
If you’re prescribed a PPI for chronic use, check with your physician to see if you still need it. Occasional use for heartburn shouldn’t be a problem. For chronic heartburn, consider a low-carb diet and stop nocturnal alcohol consumption.
Steve Parker, M.D.