As part of a recent HCUK event for heartburn and Barrett’s oesophagus patients, Dr Oliver Stovin, Heartburn Cancer UK’s GP in residence, trustee and director, talked about the pros and cons of taking PPIs (Proton Pump Inhibitors).
In an insightful session Oliver shared his experience as both a retired general practitioner (GP) and a patient. With 27 years of experience as a rural GP and more recently a cancer lead, Oliver has a unique perspective on PPIs, especially in managing Barrett’s oesophagus—a condition that can increase the risk of oesophageal cancer.
As both a professional and a patient, Oliver has a personal interest in PPIs, particularly Omeprazole, which he has been taking for over two decades. During his presentation, he shared the complexities of understanding the pros and cons of long-term PPI use, providing an in-depth review of the research available, and discussing the potential risks associated with these commonly prescribed medications.
The Role of PPIs in Treating Reflux and Barrett’s OesophagusÂ
Oliver began by discussing the effectiveness of PPIs in reducing stomach acid and alleviating reflux symptoms. For people with conditions like Barrett’s oesophagus, PPIs are widely recommended in international guidelines to slow disease progression. Oliver acknowledged that, while PPIs are effective at managing symptoms, he found limited concrete evidence on their long-term benefits, especially in preventing complications like cancer.
Although the theoretical benefit of PPIs lies in reducing inflammation—a known risk factor for cancer—the studies he reviewed did not clearly quantify their effectiveness in preventing cancer or show significant differences between various types of PPIs. However, from a practical standpoint, they continue to be the go-to treatment for managing acid reflux and preventing disease progression.
Reviewing the Risks: From Cancer to Fractures
PPIs have faced scrutiny in the media and medical studies over their long-term safety, with concerns ranging from cancer to infections and fractures. Oliver addressed these risks, examining the data and sharing his takeaways:
- Cancer Risk: Some studies suggest PPIs can increase the risk of gastric cancer by affecting gastrin and H. pylori levels. However, when weighed against the risks of Oesophageal cancer—which is more prevalent in patients like Oliver—the potential benefits of PPI use seem to outweigh the risks.
- Alzheimer’s and Dementia: Oliver explored the possibility of a link between PPIs and dementia, citing animal studies and a Danish study that hit the headlines. However, these studies were inconclusive due to compounding factors, and more rigorous research is needed to establish any clear connection. Current clinical guidelines don’t highlight dementia as a significant concern.
- Infections: Acid in the stomach plays a role in killing harmful bacteria, so there has been concern about an increased risk of infections like Clostridium difficile (C. diff) and pneumonia. Oliver emphasized that while PPIs may contribute to such risks, they are manageable with proper awareness and precautions, particularly in patients who already have higher risk factors for lung conditions.
- Fractures and Osteoporosis: PPIs can reduce calcium absorption, leading to concerns about osteoporosis and fractures. While observational studies suggest a modest increase in fracture risk, Oliver recommends that patients at higher risk of osteoporosis use a risk calculator, such as the one provided by the UK Royal Osteoporosis Society, and consider preventative treatments if necessary.
- Low Magnesium: Long-term PPI use has been linked to low magnesium levels, which can cause serious issues like heart problems and seizures. Oliver advised regular monitoring of magnesium levels in long-term PPI users, as this is an easily manageable risk.
Oliver’s Personal Experience with PPIs
Drawing from his personal journey, Oliver shared that despite his best efforts, he has been unable to reduce his dose of Omeprazole without his reflux returning. He monitors his magnesium levels and takes supplements as needed. While he has not taken specific actions regarding osteoporosis or dementia risks, he maintains a healthy lifestyle, including taking vitamin D and engaging in weight-bearing exercise.
For him, the overall benefits of PPIs—particularly in managing his Barrett’s oesophagus and reflux symptoms—outweigh the potential risks. He advises patients to stay informed, work with their doctors to monitor risk factors, and make individualised decisions based on their health status and lifestyle.
The Bottom Line: PPIs Are Generally Safe but Require Thoughtful Use
Oliver’s concluding thoughts remind us that interpreting medical research can be challenging, even for professionals. As with many medications, the effectiveness and safety of PPIs need to be evaluated on a case-by-case basis. While the risks associated with long-term use exist, they are often manageable and must be weighed against the significant benefits PPIs offer in managing conditions like reflux and Barrett’s oesophagus.
Professor Rebecca Fitzgerald, who facilitated the discussion, provided a succinct summary: PPIs, including Omeprazole, are incredibly effective for most people, and despite the many concerns that have been raised, the data suggests they are generally very safe, especially when used with appropriate monitoring.
For patients concerned about the long-term use of PPIs, the key takeaway is to stay informed, have regular check-ups, and discuss any concerns with your healthcare provider to ensure you’re making the best decision for your health.
