Chronic heartburn, caused by stomach acid splashing into the gullet, also known as acid reflux, affects many people. Proton pump inhibitors (PPIs) is popularly used to treat the condition. Available both on prescription and over-the-counter at lower doses, PPIs are among the top ten most regularly taken drugs. A study this year by University College London (UCL) involving 63,000 patients, found those taking PPIs for two weeks were twice as likely as those not on the drugs to develop stomach cancer in the following seven years.
If they stayed on them for a year, they were five times more at risk of cancer. And after three years of taking the drugs daily, the risk rose eight-fold. Scientists think PPIs may linked to cancer by stimulating a hormone called gastrin, known to play a part in triggering the growth of cancerous cells in the stomach. It is important to clarify that the UCL findings do not prove these drugs cause cancer, and researchers stressed the risk of stomach cancer in patients on the drugs is still small.
Chronic reflux can cause cells in the gullet to grow abnormally, a condition known as Barrett’s oesophagus that’s thought to affect one in ten people with reflux. Left untreated, this can develop into oesophageal cancer. PPIs such as Nexium, Zanprol, Prevacid and Prilosec, work by suppressing the release of stomach acid by cells, called proton pumps, in the stomach lining. In theory, PPIs should reduce oesophageal cancer rates by treating acid reflux.
An investigation in 2016 by Erasmus University Rotterdam in the Netherlands revealed men who regularly took PPIs were three times more likely to have low sperm counts. Meanwhile, research from Johns Hopkins University in the U.S. in 2015 found that those on PPIs were 90 per cent more likely to develop kidney failure, while a study conducted by McGill University in Canada in 2015 found that they raised the risk of hip fractures by 44 per cent. In all the studies, the longer people stay on them, the bigger the risk. In the U.S., the Food and Drug Administration (FDA) has already acted on PPI safety fears and nearly 300 patients in New Jersey have filed lawsuits in the past year or so claiming the drugs left them with kidney damage and that manufacturers knew about the risks but failed to warn them.
Stomach acid protects against infection by destroying the spores containing the C.difficile bacterium before they infect the gut. But if the stomach is producing very little acid because PPIs are being taken every day, it boosts the bug’s chances of thriving. Lab research at Stanford University in the U.S. showed that the drugs don’t just turn off acid pumps in the stomach-they also block production of acid in every cell in the body. Each cell has an area called a lysosome, which contains enzymes that help to break down damaged or defective proteins, the debris from the ageing process. But these enzymes only work properly in acidic conditions.
If the lysosome is unable to release acid to help with this process (because PPIs have blocked the mechanism), waste material builds up and cells age quicker. People with acid reflux should be able to control it by quitting smoking (a big risk factor), losing weight or raising the head of the bed by six to eight inches (which stops gravity pulling acid out of the stomach during sleep). A study this year by University College London (UCL) involving 63,000 patients, found those taking PPIs for two weeks were twice as likely as those not on the drugs to develop stomach cancer in the following seven years. If they stayed on them for a year, they were five times more at risk of cancer.
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