Why Are So Many People Taking Proton Pump Inhibitors?
Is there an epidemic of acid reflux, or is something else going on?
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I was sitting in my med school physiology class in the mid-1990s when I first learned about an incredible medication for acid reflux. It was the most potent way to stop acid production, and it did so by permanently binding to proton pumps–the pumps that make acid in the stomach lining. That medicine was called Nexium, the brand name version of omeprazole. It was the first drug of a class called proton pump inhibitors (PPIs) that would revolutionize the treatment of gut ailments.
At the time, the first-line drugs for acid reflux were H2 blockers, like Tagamet and Pepcid. They were great for handling the consequences of late-night cheeseburger binges and beer bong parties because they only temporarily reduced acid production. But some people needed all their acid production turned off. They had more severe problems like Barrett’s esophagus, which can lead to cancer, and gastritis, which can lead to bleeding ulcers. Nexium filled in this gap. There are now eight brand-name PPIs in the U.S. For many patients PPIs were–and still are– true lifesavers.
Fast forward to 2009. CNN reported that PPIs were the third most-prescribed drug in the country, representing 110 million prescriptions and $13.6 billion in sales. By 2013, more Medicare Part D money was spent on brand-name Nexium than any other prescription medication. Combined with its generic sister, omeprazole, it was the most prescribed drug overall for Medicare patients. By 2017, Nexium was one of the best-selling drugs in history.
Around 2010, doctors and researchers started noticing problems in people who took PPIs for prolonged periods of time. (Long-term use of PPIs usually means taking it for more than 6 to 12 months, but some problems can begin after taking it for only 2 weeks.) These long-term users suffered from more bacterial gut infections, including Salmonella, Campylobacter, and Clostridium difficile, as well as certain kinds of pneumonia. They also had more bone fractures and reduced absorption of magnesium and Vitamin B12. In 2018, the Mayo Clinic published a review confirming these findings and added chronic kidney disease and dementia to the list. Kind of ironic that this drug was and…
