Popular stomach acid blockers linked to higher death rates

Would love to read the study if you can find it.

> read at some point (I guess it was on Mayo Clinic)

I would strongly suggest checking your sources. Many internet "doctors" aka charlatans, state low acid is a problem. I asked my doctors at John Hopkins about this and they said it was bunk.

I tried that too. But it made no difference whatsoever.

This has been my experience as well. I found it helpful to taper the Prilosec, and move over the seemingly less dangerous Pepcid. And then taper the Pepcid to 0.

Did you adjust your diet during that period of time?

What do you think was the original cause?

so how are you controlling the burn now?

"External adjustment to estimate the impact of three unmeasured confounders, including obesity, smoking and use of therapeutics including anticoagulants, antiplatelet agents and non-steroidal anti-inflammatory drugs, shows a net confounding bias of 9.66% (see online supplementary figure 5). The total bias could move a null association between PPI and death from HR 1.00 to HR 1.10 (reflecting the net positive bias of 9.66% rounded up to 10.0%). The association we observed between PPI and death was 1.25>1.10, which cannot be fully due to bias of unmeasured confounding."

"Covariates included age, race, gender, eGFR, number of outpatient serum creatinine measurements, number of hospitalisations, diabetes mellitus, hypertension, cardiovascular disease, peripheral artery disease, cerebrovascular disease, chronic lung disease, cancer, hepatitis C, HIV, dementia and diseases associated with acid suppression therapy use such as gastro-oesophageal reflux disease (GERD), upper gastrointestinal (GI) tract bleeding, ulcer disease, Helicobacter pylori infection, Barrett’s oesophagus, achalasia, stricture and oesophageal adenocarcinoma.25–28 eGFR was calculated using the abbreviated four-variable CKD epidemiology collaboration equation based on age, sex, race and outpatient serum creatinine.29 Race/ethnicity was categorised as white, black or other (Latino, Asian, Native American or other racial/ethnic minority groups). Comorbidities except for hepatitis C and HIV were assigned on the basis of relevant ICD-9-CM (the International Classification of Diseases, Ninth Revision, Clinical Modification) diagnostic and procedure codes and Current Procedural Terminology (CPT) codes in the VA Medical SAS data sets.2 30–33 Hepatitis C and HIV were assigned based on laboratory results."

http://bmjopen.bmj.com/content/7/6/e015735

That all said, this journal doesn't have a great impact factor (2.37), so this definitely falls under "huh, this warrants further study."

There’s an obvious issue that you stomach acid is there to digest food correctly and also provide the environment for growing the correct microbiome; both of which are pretty vital functions I’d say.

They didn't find a similar effect with H2 blockers, which pretty strongly suggests a specific problem caused by the mechanism of PPIs.

Yeah, lots of risk for confounders and selection bias in a study like this. If you take the huge number of patients with a history of GI bleeding (for which PPI therapy is well-proven), those are patients who already have an elevated all-cause mortality risk. They also selected patients who had at least one creatinine measure in their EHR; so probably people who are more likely to have background renal disease. And using US veterans makes it hard to generalize to the greater population. However, they also saw elevated risk in patients who didn't have a de-facto indication for PPIs (GERD, GI bleeding, etc), so maybe there is something to this.

Honestly, it's kind of an amateur study design. I think the conclusion to draw here is we need a large randomized control study to look at this issue.

Regardless, as a physician, I agree with the study authors that if a patient doesn't have a specific indication for PPI, they shouldn't be on one. Then again, I don't need a study to tell me that; it's my feeling about ALL medications.

This study is bogus because they didn't analyze cause of death or account for the reason for using PPI.

H2 blockers and PPIs are often not prescribed for the same things. For many serious diseases PPIs are commonly prescribed as a secondary medication (eg with Plavix) where H2 blockers would make no sense. That's why the group sizes differ greatly.

I've been on them for about 10 years, for the last few years I've halved the dosage. I might have to talk to the bonesaw about halving it again with the intention of getting off them.

my experience though is that if I stop taking them I get it pretty bad and my energy levels go right out the window. I just become sloth like all day every day and cant think worth a damn.

Instances sure, but statistically significant correlations most likely not.

Biased, maybe. But the sample sizes are pretty big, whether "bigness" refers either to absolute numbers or to being big enough such that whatever they're estimating will come pretty close to the true value of that variable for similar populations. I mean, the smallest sample is 70k plus.

No, but as always they trot out the relative numbers.

    > "25% greater risk of death, compared with H2 blockers"

Whether that means anything to me depends on what my odds of dying are on H2 blockers. If it's 1 in 3 then I care. If it's 1 in 3,000,000 then I don't.