Proton pump inhibitors (PPIs) are commonly used to reduce heartburn and the risk of intestinal bleeding. Unfortunately, a new simulation-based study by the University of Michigan reports that PPI use may end up causing more harm than good. The study claims that PPIs can increase the risk of hospital-acquired infections and overall patient mortality by an overwhelming amount.
The study in question was performed using a simulation meant to replicate hospital patients over the course of various stays. It was found that beginning the use of PPI on inpatients increased hospital mortality in 90% of simulated patients. In cases where existing PPI therapies were continued on admitted patients, the death rate increase was seen in 79% of cases. The exact cause of the deaths was not stated and it is unclear if the simulation was able to produce that data.
Although the PPI treatments were found to properly reduce the occurrence of gastrointestinal bleeding, they also resulted in an increase of hospital-acquired infections. Specifically, patients on PPIs were found to have higher rates of hospital-acquired pneumonia and Clostridium difficile infections. The cause is thought to be due to how PPI treatments reduce the potency of stomach acid; one of their known side effects and the reason they are also used for managing heartburn. Stomach acid is useful for both protecting a person’s gut flora and for preventing invading bacteria from getting a good foothold in the body. With the acid weakened, infection becomes more likely. The increased vulnerability to C. difficile is actually known by the FDA, which has applied the appropriate warnings to PPI treatments.
It is not entirely clear how well the simulation results would translate to real world conditions. A proper clinical trial, according to the study authors, would take around 64,000 participants and the ubiquity of PPI medications on the market lead the authors to believe they would not be able to find funding.
At any given time, about half the patients in an American hospital are on PPIs, whether as a result of being on the medication prior to being admitted or being administered the drugs as part of standard protocol. PPIs are also part of many hospital rules-of-thumb for different drug plans. If a patient is given high-dose steroids, for instance, PPIs are often automatically prescribed to reduce the risk of gastrointestinal bleeding, which steroids can cause.
Sources for Today’s Article:
“First, Do No Harm: Hospital Patients given Anti-heartburn Drugs Have Higher Risk of Dying,” EurekAlert! web site, November 10, 2015; http://www.eurekalert.org/pub_releases/2015-11/uomh-fdn110615.php.
Pappas, M. et al., “Defining Appropriate Use of Proton-Pump Inhibitors Among Medical Inpatients,” Journal of General Internal Medicine, 2015; doi: 10.1007/s11606-015-3536-7.
“Proton Pump Inhibitors Information,” U.S. Food and Drug Administration web site, https://www.fda.gov/Drugs/DrugSafety/InformationbyDrugClass/ucm337066.htm, last accessed November 10, 2015.