PPI Use Linked to Elevated Mortality Risk

PPI Use Linked to Elevated Mortality Risk

During a median 10 years’ follow-up, 37% of participants died. There were 46 excess deaths per 1000 PPI users in that time. PPIs were associated with excess mortality from cardiovascular disease (CVD) and chronic kidney disease (CKD). Patients without indications for PPI use had higher mortality risk from CVD, CKD, and also upper gastrointestinal cancer. Longer duration of use was associated with greater risk.

The NEJM Journal Watch summary has a link to the full study from BMJ.

Gastric Cancer Risk Doubled With Long-term PPI Use

Source: Gastric Cancer Risk Doubled With Long-term PPI Use

The study was published online October 31 in Gut.

The researchers point out, however, that this was an observational study, which can’t prove cause and effect.

A strength of the study is its use of data from a large population-based database with complete information on subsequent diagnoses and drug prescriptions, which minimizes selection, information, and recall biases, the researchers say. Use of strict exclusion criteria as well as propensity score adjustment to control for potential confounders and restricting the sample to patients with successful H pylori eradication are other strengths.

In terms of study weaknesses, the researchers  lacked information on some risk factors, such as diet, family history, and socioeconomic status.  And despite the large sample of more than 63,000 H pylori–infected patients, the small number of gastric cancer cases did not allow for any “meaningful evaluation of the dosage effect and role of different PPIs,” the researchers say.

Mediterranean-style diet may eliminate need for reflux medications — ScienceDaily

Source: Mediterranean-style diet may eliminate need for reflux medications — ScienceDaily

When compared to patients who took the traditional reflux medication, proton pump inhibitors (PPI), those patients who consumed a 90-95% whole food, plant-based, Mediterranean-style diet paired with alkaline water had the same if not better reduction in reflux symptoms. 62.6 percent of patients treated with a plant-based diet and alkaline water saw a six point reduction in their Reflux Symptom Index (RSI — a measurement for the severity of reflux symptoms), compared to 54.1 percent reduction in patients taking PPI’s. Though this research only focused on those with laryngopharyngeal reflux, this same diet regimen has implications to help patients with gastro-esophageal acid reflux (also known as GERD).

The diet suggested by Dr. Zalvan consists of mostly fruits, vegetables, grains and nuts with near complete cessation of dairy and meats including beef, chicken, fish, eggs and pork. This is in addition to standard reflux diet precautions like avoiding coffee, tea, chocolate, soda, greasy and fried food, spicy foods, fatty foods and alcohol. Along with relieving reflux symptoms, Dr. Zalvan noted that many of his patients who were treated with a plant-based diet also experienced some weight loss and a reduction of symptoms and medication use from other medical conditions like high blood pressure and high cholesterol. Dr. Zalvan said that a plant-based diet approach with alkaline water and standard reflux precautions should either be attempted prior to the use of medication or with the short-term use of medication for more severe needs.

PPIs Tied to Increased Risk for Chronic Kidney Disease | Medpage Today

In a prospective, community-based study involving more than 10,000 adults followed for a median of 14 years, baseline use of a proton pump inhibitor (PPI) was independently associated with a 20% to 50% higher risk for incident chronic kidney disease (CKD).

Source: PPIs Tied to Increased Risk for Chronic Kidney Disease | Medpage Today

I got heartburn reading this article.