Proton pump inhibitors (PPIs) are medicines that work by reducing the amount of stomach acid made by glands in the lining of the stomach. Many use PPIs to prevent Gastroesophageal Reflux Disease (GERD), to heal inflammation of the esophagus, and to prevent complications until the esophagus is healed. However, the warning label says that PPIs should only be used short term. In fact, long-term use can produce a variety of dangerous side effects.

Types of PPIs

There are many different kinds of PPIs on the market. The most popular brands are:

• Prevacid
• Prilosec
• Nexium

Study Links PPIs to Chronic Kidney Disease

Roughly, 15 million Americans use PPIs every year. Out of these, 20-50% are at a higher risk of chronic kidney disease compared with nonusers. The study published by JAMA Internal Medicine warned not to take PPIs at all or to use only for the shortest possible duration. Those that increased their dosage also increased their risk of kidney disease. Kidney disease occurs when the kidneys lose their ability to filter blood effectively. This can lead to end-stage renal failure, which is the need for life-long dialysis treatment or even a kidney transplant.

PPIs Linked to Acute Interstitial Nephritis

In 1992, it was first noted that PPIs cause Acute Interstitial Nephritis (AIN). Each new study described the 5 times greater risk users have in developing this deadly infection. AIN is a drug-induced bacterial infection of the kidneys. Nearly all cases of AIN are directly caused by taking PPIs. The treatment is either drug removal, dialysis, or a kidney transplant. However, PPIs have a high rebound rate. This means that when the drug is stopped most people have such a high dependency on it that they must continue to use it just to feel better. The cycle continues until patients end up on dialysis or death.

It was not until December 2014 that the FDA issued a new warning about the association between Prevacid and kidney issues. This warning outlined the potential risk of developing acute interstitial nephritis, the sudden inflammation of the kidneys. The actual side effects of PPIs are much worse. The FDA neglected to warn consumers that PPI users have a 50% risk of developing acute kidney injury, chronic kidney disease, and even kidney failure.

PPIs & Chronic Liver Disease

Around 10% of Americans use PPIs, which brings seven times higher risk of developing chronic liver disease. The researchers at the University of California San Diego School of Medicine found that mice with gastric acid suppression developed alterations in their gut. Specifically, this bacteria named Enterococcus. These changes caused an environment favorable to liver inflammation and liver injury. It also increased the progression of liver disease in the mice used during the experiment.

Senior author of the study, Bernd Schnabl, MD, associate professor of gastroenterology at UC San Diego School of Medicine noted that the rise of chronic liver disease is related to more people using PPIs.  “We believe clinicians should consider withholding medications that suppress gastric acid unless there is a strong medical indication,” Schnabl said.

Chronic liver disease is the 12th leading cause of death worldwide and that number is rapidly increasing. PPIs, which include brand names such as Prilosec, Nexium, and Prevacid, are the most common doctor-prescribed medications in the world. They are also relatively inexpensive medications, costing around $7.  The longer the use the more costly it becomes. Americans spend around $11 billion each year on PPIs.

Long-term PPI Use Could Lead to Stomach Cancer

PPIs & Esophageal Cancer

On February 22, 2018, Cancer Epidemiology published a study led by Dr. Nele Brusselaers and his team at Karolinska University Hospital in Stockholm. The study used data from four national registers in Sweden to identify almost 800,000 patients taking PPIs. They found that those using PPIs had a near double rate of developing esophageal cancer than those who did not. Unlike the other cancers mentioned, researchers found that even using PPIs for a short amount of time still caused esophageal cancer.