Are there health risks linked to heartburn medications?

Over-the-counter and prescription proton pump inhibitors (PPIs), a class of heartburn medications used to treat gastroesophageal reflux (GERD), are taken regularly by an estimated 15 million people in the U.S. These medications block the production of stomach acid to prevent acid reflux and heartburn. While the drugs are effective at reducing the symptoms of GERD, several different studies suggest that the relief they provide may come with unexpected health risks.

What are the risks?

Studies have found an association between the long-term use of PPIs and using higher doses of these types of heartburn medications and several different kinds of health problems, including:

• An increased risk of bone fractures due to a reduction in the body’s ability to absorb important nutrients, vitamins, and minerals, including calcium, magnesium, and vitamin B12
• Reduced effectiveness of the prescription blood thinner clopidogrel, which is prescribed to prevent blood clots in people with certain types of heart disease and those who have had a stroke or heart attack
• Slower elimination of the immunosuppressant drug methotrexate, used to treat rheumatoid arthritis and some forms of cancer, from the body
• A higher risk of pneumonia
• A greater risk of infection with the bacteria Clostridium difficile, which can cause chronic, difficult to treat diarrhea
• More susceptibility to food poisoning caused by salmonella bacteria
• An increased risk of kidney disease
• A higher risk of asthma and allergies in children whose mothers took PPIs while pregnant

A new European study also found an association between regular PPI use and an increased risk of dementia. In this study, the researchers reviewed a prescription database to examine PPI use in more than 73,000 men and women older than 75. All of the people studied did not have dementia at the start of the study. After an average of five years’ of follow-up, 29,000 of the people in the study had developed Alzheimer’s disease or other types of dementia.

The researchers controlled for other factors that can contribute to the development of dementia, including age, sex, depression, diabetes, stroke, heart disease, and the use of other medicines. After controlling for these factors, they found an association between regular PPI use and a 52 percent increase in dementia risk for men and a 42 percent increase in women compared to people who did not take PPIs.

Does this mean you shouldn’t take PPIs?

It’s important to remember that none of the studies undertaken to date have made a direct connection between using these heartburn medications to manage the symptoms of GERD and an increased risk for these health problems. If you do have frequent acid reflux and take either prescription or over-the-counter PPIs, talk with your doctor about the benefits and risks.

You may be able to decrease your need for these medications by making some lifestyle changes, such as:

• Losing weight
• Avoiding fatty, spicy, and acidic foods and caffeinated and carbonated drinks
• Eating smaller meals and not eating close to bedtime
• Quitting smoking
• Drinking fewer alcoholic beverages

Depending on your particular situation, making these changes may improve your symptoms and your doctor may recommend less frequent or lower dosages of medication. If you take over-the-counter PPIs, be sure to ask your doctor if this type of medication is appropriate for your symptoms and how long you should continue to take it.