Are Acid Reflux Drugs Overused?
Studies Suggest Many People Taking Them Don't Need Them and May Be Putting Their Health at Risk
People Like PPIs Because They Work continued...
What's the harm?
Plenty. "If you take them indiscriminately, you reduce the benefit-to-risk ratio," Romero says.
Published studies have linked PPIs to an increased risk of potentially deadly diarrhea caused by the bug Clostridium difficile, or C. diff. There's also a slightly increased risk of fracture in some risk women taking PPIs at high doses and/or for extended periods of time.
Several studies have shown that people who take a PPI may be more likely to catch pneumonia. Suppression of stomach acid may also reduce the body’s ability to absorb calcium and magnesium, Romero says.
And they’re not cheap, she adds. A year's supply of over-the-counter Prevacid 24HR costs about $200. If you're prescribed a more expensive PPI, the annual price tag could be 10 times higher or more.
When to Take -- and Not Take -- PPIs
The bottom line: "We have to educate patients and doctors on when and how to use PPIs," she says.
That means prescribing them only for serious conditions that occur when stomach acid escapes into the esophagus -- reflux disease and Barrett's esophagus, for example, Romero says. They're also used to prevent and treat ulcers in the small intestine and the stomach, among other conditions.
When PPIs are used, she advises doctors to use shorter courses and lower doses when possible. And just because they’re available at the local store, people shouldn't start popping the pills without telling their doctors.
"We also need to train doctors so they know it's OK to stop a PPI after it's started. Just because it’s good for them in the intensive care unit doesn’t mean they have to stay on it," Romero says.
Doctors and patients should consider other treatments for heartburn, including non-drug treatments such as stress reduction, weight loss, and smoking cessation, she says.
PPIs: the Studies
Among the new research presented at the meeting:
- In Smith's study, 204 of 358 patients (60%) were prescribed a PPI while in the hospital. The most common reason cited for prescribing a PPI was that patients were already on a PPI prior to admission.