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Source: Thailand Medical News  Apr 08, 2019  5 years, 1 week, 21 hours, 3 minutes ago

As Evidence of Damage from Long-Term PPI Use Mounts, Thai Medical Providers Should Rethink Strategies to Treat Acid Reflux

As Evidence of Damage from Long-Term PPI Use Mounts, Thai Medical Providers Should Rethink Strategies to Treat Acid Reflux
Source: Thailand Medical News  Apr 08, 2019  5 years, 1 week, 21 hours, 3 minutes ago
This article has been specially commissioned by Thailand Medical News to bring about awareness and also create caution about the excessive usage of PPIs (Proton Pump Inhibitors) that is over prescribed currrently in Thailand to treat acid reflux conditions.
as evidence

A recent landmark population study by US researchers at the University of California -- San Diego has indicated that Proton pump inhibitors (PPIs) may cause renal dysfunction and a variety of kidney-related diseases. The researchers analyzed complaints from over 43,000 American patients registered in the American Food and Drug Administration (FDA)’s Adverse Effect Reporting System (FAERS), a government database program designed to record negative effects of drugs through self-reporting by patients and physicians. Since their introduction to the US market in the 1980s, PPIs have become a common treatment for gastroesophageal reflux disease (GERD), known colloquially as acid reflux, across the world. In Thailand, the PPI class of drugs is widely prescribed by physicians for patients with gastrointestinal tract problems, most commonly in the form of omeprazole, a generic version of the more well-known brand Prilosec.
 
The discovery of a connection between renal disease and PPI use prompts a wider discussion on the safety of these drugs. In addition to kidney-related problems caused by these medications, a growing body of evidence indicates that PPIs may also cause a host of liver problems, including cancer, as well as ischemic stroke – extremely serious, potentially fatal conditions that warrant more careful consideration by doctors when deciding whether PPI use is suitable for acid reflux treatment.
 
The medical literature indicates a strong connection between the time a patient regularly takes PPIs and the likelihood of serious adverse effects. So, while short-term use can be beneficial, Thai doctors should consider new forms of treatment for patients who have taken these medications for months or years.
 
damage from

When PPIs were initially approved for medical use in the 1980s, little was known of the extent to which they could potentially cause serious side effects. Prescribers and patients were advised of mostly moderate, easily managed effects like headache or diarrhea. Because in many cases PPIs can be effective in alleviating symptoms of GERD, ulcers, and a variety of other gastrointestinal issues, the benefits at the time seemed to outweigh the cost. Doctors began prescribing PPIs on a large scale, and for over the last 40 years have become one of the most common prescription drugs in the world, including Thailand.   
 
Pharmaceutical manufacturers make enormous profits from the sale of proton pump inhibitors. According to a report released by the National Institutes of Health, “more than 15 million Americans used prescription PPIs in 2013, costing more than $10 billion US dollars.” Many of these drugs have become available without a prescription in recent years, boosting sales by increasing availability and potentially reducing consumers’ concerns over their safety, as over-the-counter med ications are considered “safer” than those requiring a prescription.
 
In particular, the PPI omeprazole, an extremely common proton pump inhibitor, should concern physicians and public health policymakers in Thailand. Here, a generic version of the drug called Miracid is prescribed to over 700,000 local Thais and 350,000 mostly Western expats.
long term
 
Options exist for alternative acid reflux treatments which are worth exploring and which do not have the significant downsides of PPI regimens. In light of the mounting evidence showing fatal consequences for patients taking PPIs like Miracid, especially over long periods of time, Thai medical providers should consider shifting to new methods for treating GI conditions like acid reflux. IN a broader view, public policy initiatives -- in particular nutrition education, smoking awareness campaigns, and exercise promotion -- can help curb the continued increase of acid reflux cases in Thailand by limiting the proven casual factors explored further below.
 

Evidence of Renal Dysfunction Caused by PPIs

 
In the UC – San Diego study, researchers scoured the records of over 40,000 patients who had taken PPIs for the treatment of acid reflux alone, without any combinations with other medications. Those patients’ records were compared to a control group consisting of patients who had been treated histamine-2 receptor blockers (another common acid reflux treatment) to determine the correlation between PPI intake and kidney disease. They discovered that 5.6% of patients taking PPIs reported kidney problems. In contrast, just 0.9% of patients who took histamine-2 receptor blockers reported the same issues.

Patients who had taken PPIs were significantly more likely to experience chronic kidney disease and end-stage renal disease, with a 28.4 and 35.5 times more frequent occurrence compared to histamine-2 receptor blocker-treated control group, respectively.
 
The researchers cautioned that, although the correlation between PPIs and kidney disease has been demonstrated in this study, more clinical tests are needed to establish a definite causal relationship.

 
PPIs Potentially Cause Liver Cancer

 
In October 2017, the medical journal Nature Communications published a study which concluded that drugs like omeprazole contribute to and/or primarily cause a variety of potentially fatal liver conditions. In their research, they discovered that “proton pump inhibitors promote progression of alcoholic liver disease, non-alcoholic fatty liver disease, and non-alcoholic steatohepatitis in mice by increasing numbers of intestinal Enterococcus spp.”
 
In a previously unknown mechanism of action, proton pump inhibitors were seen to increase specific intestinal bacteria, Enterococcus faecalis, which in turn worsened the subject mice’s liver conditions.
 
The researchers continued with a caution to doctors to explore alternatives to PPI prescription: