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PPI antacids such as Aciphex, Dexilant, Nexium, Prevacid, Prilosec and Protonix are linked to increased risk of a bacterial infection and broken bones, say studies published in the May 10 issue of Archives of Internal Medicine.

Proton pump inhibitors (PPIs) are a class of drug that reduces the production of stomach acid by blocking a certain enzyme in the stomach wall that produces acid. Doctors prescribe these drugs for patients suffering from ulcers, gastroesophageal reflux disease (GERD) and Zollinger-Ellison syndrome.

Proton pump inhibitors are big business in the United States.

“A staggering 113.4 million prescriptions for proton pump inhibitors (PPIs) are filled each year, making this class of drugs, at $13.9 billion in sales, the third highest seller in the United States,” wrote Mitchell H. Katz, MD, San Francisco Department of Public Health, San Francisco, CA in an editorial accompanying the PPI studies.

Katz says PPIs are over-prescribed, with between 53% and 69% of PPI prescriptions for inappropriate indications and suggests that risks associated with use of PPIs outweigh the benefits in many patients.

One study published in the JAMA publication by Dr. Michael D. Howell of Beth Israel Deaconess Medical Center and his colleagues; found that daily PPI use is associated with a 74% increase in Clostridium difficile infection.

Clostridium difficile, also known as “C. diff” is a germ that can cause diarrhea. Most cases of C. diff infection occur in patients taking antibiotics. The most common symptoms of a C. diff infection include watery diarrhea, fever, loss of appetite, nausea, belly pain and tenderness.

Typically, people contract C. diff by touching an infected surface and then touching their mouth or by eating contaminated food. Stomach acid usually kills C. diff, therefore reduced stomach acid places people at higher risk for developing C. diff infection.

Another study by Amy Linsky, MD of the Boston Medical Center and colleagues discovered that patients in a hospital treated for C. diff infections were 42% more likely to have the infection return if they were taking PPIs.

Between 2000 and 2005, C. diff infections in the United States doubled. In 2005, more than 300,000 people became ill from the bacteria and about 28,600 people died from the infection.

Also published in the May issue, a study by Shelly L. Gray, PharmD, of the University of Washington, Seattle, WA and colleagues finding that postmenopausal women currently using PPIs were 47% more likely to have had a spine fracture, 26% more likely to have a forearm or wrist fracture and 25% more likely to have any kind of fracture. The study found no link between PPIs and hip fractures.


  1. Gravatar for Facebook User

    The approach of giving "medicine" to basically healthy people in a bid to either prevent future disease or treat a symptom of a disease is more often than not a losing proposition. There are probably few foods one could eat every single day for years on end and not expect some difficulty. To suspect that one can take, the latest synthetic laboratory chemical concoction, heretofore unseen by human physiology or even nature, and derive a net benefit over years of use is at best blithely optimistic and more likely something akin to pharmaceutical Russian Roulette.

    Unfortunately, if one considers corporations to be amoral, their concern is not with health it is with profits, which is why so many drugs are designed for chronic conditions which still allow the user to be a wage earner while taking the drug. From the company's point of view, if chronic exposure to the drug causes a second condition, which does not debilitate the customer but allows them to continue to earn a wage while needing a second chronically administered drug this would be a "win/win".

    As a compromise, companies should begin by going back and characterizing all the off-target effects of currently approved drugs, thus allowing them to pursue additional indications while improving drug safety.

    Paul D. Maher, MD MPH

    P.S. While not making light of people who suffer with GERD, and with alternative health being outside my area of expertise, I have found from personal experience that, counter-intuitively enough, a little dollop of apple cider vinegar does wonders for me if I have indigestion.

  2. Gravatar for Rick Locke

    I've been taking PPI's for roughly the past 10 years. 2 months ago while playing golf I grounded my club a little more forcefully than usual to complete a high lofted shot and broke the ring finger knuckle on my right hand. I was shocked (and in pain). This is a shot I have taken dozens of times with no ill effects. Thanks to your article we may have found the smoking gun. I have an appointment with my doctor tomorrow morning.

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