Heartburn drugs can harm kidneys

Many people who suffer from heartburn find relief by taking over-the-counter medications, known technically as Proton Pump Inhibitors (PPIs).

These include Omeprazole, Pantoprazole and the likes. Although these drugs are widely used, concerns are mounting over their long-term effects.

These drugs are safe when used for short period of time but some people continue using them indefinately against the advice of health professional.

Yes, it does provide excellent solution for your heartburn but is it worth it?

Heartburn is a common symptom caused by acid reflux, whereby some of the stomach contents (including stomach acid) are forced up into the esophagus, creating a burning pain in the lower chest.

Persistent acid reflux that happens more than twice a week results in the diagnosis of gastroesophageal reflux disease (GERD). The condition can be very unpleasant. Since proton pump inhibitors (PPIs) are easily available and clear up symptoms quickly, they have become very popular. In 2006, an estimated $7 billion was spent on PPIs globally according to an online source.

Gastroesophageal reflux disease is seen in people of all ages and the cause is often attributable to a lifestyle factor. However, it can also be due to unavoidable factors such as genetic abnormalities (autosomal) affecting the sphincter muscles (valve) at the top of the stomach.

PPIs were never approved for long-term use by regulatory authorities and recent studies have shown a number of worrying “correlations”.

They work by reducing the amount of stomach acid made by cells in the lining of the stomach, thus providinfg relief from heartburn. They are not the same as antacids, which work by neutralizing excess acid after it has entered the stomach.

PPIs are also used to treat peptic or stomach ulcers and damage to the lower esophagus caused by acid reflux.

There are many PPI brands. Although most work equally, side effects may vary.

One study which has demonstrated links between them and a range of health conditions is that from Johns Hopkins University in Baltimore, published in JAMA Internal Medicine. The study suggests that taking this class of drugs commonly used to reduce acid in the stomach is linked to a higher risk of developing chronic kidney disease, compared with not taking them.

In an another editorial article - Drs. Adam Jacob Schoenfeld and Deborah Grad of the University of California - San Francisco, summarizes recent evidence on the adverse effects of taking PPIs. The article notes that “A large number of patients are taking PPIs for no clear reason - often remote symptoms of dyspepsia or ‘heartburn’ that have since resolved.”

PPIs are associated with increased risk for chronic kidney disease (CKD), according to two population-based analyses published online January 11 in JAMA Internal Medicine.

The authors suggest the widely used drugs might be part of the reason CKD prevalence has risen faster than would be expected from the trends in known CKD risk factors, such as diabetes mellitus and hypertension.

Therefore, senior citizens are at a higher risk compared to young population on same duration of exposure to the PPIs.

Healthy kidneys are crucial to the human body. These two bean-shaped internal organs clean the blood by filtering waste and extra water which leaves the body through urine. They also stabilize bodily levels of electrolytes, which are minerals that impact fluid levels, blood acidity, muscle operations and other processes. Additionally, kidneys generate hormones that serve important functions such as keeping the bones strong.

When the kidneys suffer damage, excess fluid builds up in the body and lower extremities.

This can cause swelling in the ankles. Nausea and vomiting often occur. Damaged kidneys cannot keep the blood clean, and the body deteriorates quickly.

In fact, a person cannot survive for very long without functioning kidneys. Other studies suggests that PPIs don’t only affect the kidneys but also other systems in our body.

Heart disease and dementia have all been linked to long-term PPI usage. However, studies to date have only been able to demonstrate correlation, rather than causation. Also, until now, no known mechanism has been uncovered that can explain the findings.

In the wake of this, an alarm should be sounded and unnecessary prescribing of PPIs should be avoided especially in pregancies. Physicians and all other health-care workers should follow the following techniques to reduce this trend;

Talking to your patients: Inform patients that, while this study does raise some concern about long-term PPI use and the potential contributions to kidney disease, the study does not show that PPI use causes kidney disease. No decisions should be made in haste as a reaction to this study.

Consider various options for how your patient would like to move forward. Some patients may wish to consider trying an H2 antagonist instead of a PPI.

Recommend that patients also consider lifestyle modifications that may reduce or eliminate the need for PPIs for long term use, as was concluded in the study “Lifestyle Intervention in Gastroesophageal Reflux Disease.”

Keep conversation channels open with patients. Tell them that many patients require long-term use of PPIs as a highly effective therapy for many conditions. They shouldn’t stop medication without first talking with you about the risks and benefits. The need for PPIs should be periodically reassessed. Be sure to stay up-to-date on proper PPI tapering strategies.

And finally, reassure patients that the benefits of using PPIs often outweigh the possible risks. Let them know that you prescribed a PPI for a clear-cut indication, in the lowest possible dose, and for an appropriate period of time (lowest dose, shortest time).

“Generally, the drugs are very well tolerated, and the vast majority of patients who take them will not develop (kidney failure) or other serious problems,” lead study author Tony Antoniou, a researcher at the Institute for Clinical Evaluative Sciences and St. Michael’s Hospital in Toronto told Reuters. “But the drugs should be used for the shortest possible duration.”