Monday, November 20, 2017

Are Some Heartburn Meds Tied to Stomach Cancer?

Popping certain heartburn drugs like they’re candy might up your odds for stomach cancer, new research suggests.

The risk was proportionate to how long and how often these drugs, called proton pump inhibitors (PPIs), were taken. That risk increased anywhere from two to eight times, the study authors said.

Although the relative risk seems high, the absolute risk was small. But it was statistically significant, especially for people infected with Helicobacter pylori, a bacteria linked to stomach cancer, the researchers explained.

“While PPIs are one of the most commonly used medications for treating reflux disease as well as dyspepsia, clinicians should exercise caution when prescribing long-term PPIs, even to patients who have H. pylori eradicated,” said lead researcher Dr. Wai Keung Leung. He is a professor of gastroenterology at the University of Hong Kong.

PPIs include commonly used drugs like Prilosec, Nexium and Prevacid.

Eliminating H. pylori lowers the risk of stomach cancer significantly, Leung noted. But even after the bacteria is treated, many people still develop stomach cancer.

Stomach cancer is the third leading cause of cancer death in the world and earlier studies have found a link between PPIs and stomach cancer. But the role of H. pylori was less clear.

To try to assess the role the bacteria played, Leung and his colleagues compared the use of PPIs with another class of drugs used to lower stomach acid – histamine H2-receptor antagonists (H2 blockers). The study followed nearly 63,400 patients treated with a combination of a PPI and two antibiotics to kill H. pylori. The treatment was given over seven days between 2003 and 2012. The patients were followed for an average of seven years, until the participants either developed stomach cancer, died, or the study ended.

In total, 153 people developed stomach cancer after being treated with a PPI and two antibiotics. Taking PPIs was linked with more than twice the risk of developing stomach cancer, while taking H2 blockers was not associated with any increased risk, the researchers found. In addition, people who took PPIs every day had more than four times the risk for stomach cancer, compared with those who used the drug once a week. And the longer PPIs were used, the greater the risk.

The report was published online Oct. 31 in the journal Gut.

My Take:
PPIs were designed to be used for temporary relief of GERD symptoms. Dosing is recommended for up to two months. However, many patients take these medications daily for years, especially the elderly.

By blocking proton pump production in the stomach, PPIs essentially stop digestion. This creates malnutrition resulting in anemia, osteoporosis and a loss of general health. The association with stomach cancer is less clear but appears to be related to the germ-killing capacity of stomach acid. Hydrochloric acid secretion is an early immune defense against bacteria in our food.

The Bottom Line:
If you must take a PPI for temporary relief of GERD, limit the duration to two months, preferably two weeks. Then transition to an antacid, again limiting the duration. If you cannot make this transition yourself, see a qualified nutritionist for guidance. PPIs are the first drug that physicians choose to stop in the elderly when trying to reduce or eliminate polypharmacy.

Source: October 31, 2017 National Institutes of Health

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