Long-term use of PPIs not linked to all-cause mortality or gastroenterology complications: AGA

USA: In a new study conducted by Chun-Han Lo and the team it was shown that after controlling for protopathic bias, proton pump inhibitor (PPI) usage was not linked with an increased risk of all-cause mortality or gastroenterology complications. The findings of this study were published in the Gastroenterology journal. 

Proton-pump inhibitors (PPIs) are a family of medications well recognized for their usage in acid-related illnesses. Omeprazole, medicine in this family, is one of the top ten most prescribed medications in the United States. PPIs are heterocyclic organic compound benzimidazole derivatives. They are frequently used as first-line agents by gastroenterologists.

Researchers used data from the Nurses' Health Study (2004-2018) and the Health Professionals Follow-up Study to perform a prospective cohort study (2004-2018). The hazard ratios (HRs) and 95 percent confidence intervals (CIs) for death based on PPI usage were estimated using Cox proportional hazards models. To reduce reverse causality, they used a modified lag-time technique (i.e., protopathic bias).

The key findings of this study were as follows:

1. 22,125 fatalities were observed among 50,156 women and 21,731 men tracked for 832,026 person-years and a median of 13.8 years, including 4,592 deaths from cancer, 5,404 deaths from cardiovascular illnesses, and 12,129 deaths from other causes.

2. PPI users had considerably greater odds of all-cause death and mortality owing to cancer, cardiovascular disease, respiratory illness, and digestive disease compared to non-users.

3. The relationships were diminished and no longer statistically significant after adding lag times of up to six years.

4. PPI usage for a longer period of time did not increase the risk of all-cause and cause-specific death.

In conclusion, the findings of this study clearly indicate that the long-term usage of proton pump inhibitors is not associated with cases of gastroenterology complications. The working staff should consider this and hand out the PPI whenever needed.

Reference:

Lo, C.-H., Ni, P., Yan, Y., Ma, W., Joshi, A. D., Nguyen, L. H., Mehta, R. S., Lochhead, P., Song, M., Curhan, G. C., Cao, Y., & Chan, A. T. (2022). Association of Proton Pump Inhibitor Use With All-cause and Cause-specific Mortality. In Gastroenterology. Elsevier BV. https://doi.org/10.1053/j.gastro.2022.06.067