Proceed with Caution: Acid Suppressants and Mortality Risk

Scanning electron micrograph of Clostridium di...
Scanning electron micrograph of Clostridium difficile bacteria.. Obtained from the CDC Public Health Image Library. Image credit: CDC/ Lois S. Wiggs (PHIL #6260), 2004. (Photo credit: Wikipedia)

I’ve been on omeprazole for eighteen months now and don’t like it one bit.  Like all drugs, it’s a trade off in risk.  Along the way to a cure or relief, side effects can work misery for you.  Omeprazole is what we call an acid blocker, designed to relieve the symptoms of too much acid in the stomach, often resulting in heartburn, a key symptom of GERD, or acid reflux.  More formally, we call them PPIs, an acronym for proton pump inhibitors.  Millions of us take them, sometimes for gastritis, esophagitis, and ulcers as well as for heartburn.  In fact, they’re the second most prescribed medication in America.  You can get omeprazone over the counter

Acid blockers are potent, altering the normal balance of acid and alkaline in your stomach, a balance critical to sound nutrition.  They mug, for example, needed vitamins and minerals like B12, vitamin D, calcium, iron and zinc.  They can make you anemic.

They may also do damage to your bones when taken for a protracted period, leading to hip fractures, though research, sometimes contradictory, hasn’t provided a clear-cut finding on this.

It’s universal, however, that PPIs can lead to a Clostridium difficile infection.  The FDA has been so concerned that it issued an alert on the danger in 2010 and of its consequent, severe diarrhea.  C. difficile is especially menacing to the elderly.

You diagnose it through a stool sample.  If confirmed, they put you on a round of antibiotics.  It isn’t, however, easy to get rid of, as it’s highly resistant.  C. difficile can survive a lack of moisture and collects on many surfaces, then spreads through hand contact.  It’s resistant enough that even alcohol containing hand sanitizers can’t kill it.  For the most part, you get it in a hospital or nursing home.

One of the perils of PPIs is that they do their job so well in reducing stomach acid that C. difficile can ravage your stomach with impunity.  But the real kicker is in the findings of a recent study:  C. difficile is especially hard on PPI users.  In fact, they’re five times more likely to die from it than those not taking PPIs, or its cousins, H2 blockers.  This study, published in the Clinical Infections Diseases journal (Oct. 5, 2011), included 485 patients with the infection at the Naval Medical Center (2004-2008).  Half of those infected were on acid suppressants, with the  majority on PPIs.  Of the 485 infected, 23 died from C. difficile.  19 of the 23 were on acid suppressants.

This has led Dr.  Edith Lederman, an infectious disease expert at the Naval Medical Center, to caution that “stomach acid is a very important defense mechanism against pathogens.  It kills them.” Although there isn’t “enough data that people should forgo use of acid suppression, clinicians and patients need to be aware of the potential consequences.”

As the saying goes, “Sometimes the cure is worse than the disease.”  Doctors often prescribe medications indiscriminately, not taking in the patient’s medical history, contraindications, age, and sensitivity.  This behooves you and me to always do our own research and proceed with upmost caution.  Our lives may depend on it.


Author: RJ

Retired English prof (Ph. D., UNC), who likes to garden, blog, pursue languages (especially Spanish) and to share in serious discussion on vital issues such as global warming, the role of government, energy alternatives, etc. Am a vegan and, yes, a tree hugger enthusiastically. If you write me, I'll answer.

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