Proton pump inhibitors (PPIs) are amongst the most widely prescribed drugs in the world. One of their prime indications is for the treatment of Gastro-esophageal Reflux disease (GERD), which affects 10-20% of the population, and as such presents a huge market for the use of these drugs (Mospan etal, 2015). The use of these drugs though comes with some serious side effects including increased rates of vitamin B12 deficiency, iron deficiency (Qorraj-Bytyqi etal, 2018; Hansen etal, 2017; Purchiaroni etal, 2015; Lam etal, 2013; Wilhelm etal, 2013) and magnesium deficiency and has also been associated with a higher risk of bone fracture and dementia (Wilhelm etal, 2013; van Herwaarden etal, 2016). Even short term use of PPIs has been shown to result in "clinically significant impairment in visual memory, attention, executive function, and working and planning function (Akter etal, 2015).
Data from Qorraj-Bytyqi etal, 2018
Despite countless reviews that cite that long term use of PPIs leads to vitamin B12 deficiency, iron deficiency, dementia, (Schubert, 2017; Maes etal, 2017; Singh etal, 2018; Savarino etal, 2018, Miller 2018; Nehra etal, 2017; De Bruyne and Ito, 2018; Linder etal, 2017; van Herwaarden etal, 2016; Oh, 2011) as well as electrolyte imbalance, gastric tumors, enteric infections, spontaneous bacterial peritonitis, pneumonia, ischemic heart attacks, and thrombocytopenia (Muherjee etal, 2018). Despite this, a number of Gastroenterologists (Freedberg etal, 2017; Savarino etal, 2016) appear to have disregarded these findings and have stated users should not routinely raise their intake of calcium, vitamin B12, or magnesium beyond the Recommended Dietary Allowance (RDA)." Further "Long-term users should not routinely screen or monitor bone mineral density, serum creatinine, magnesium, or vitamin B12. (Freedberg etal, 2017). It is curious that this dismissal of the long term effects of PPIs on vitamin B12, iron, magnesium and bone mineral density comes primarily from Gastroenterologists, the very people who would be prescribing the drugs! It is also curious that they are suggesting that people do not monitor their levels, a practice that would eventually bury the association between PPI use and deficiency in B12, iron and magnesium, potentially to the detriment of the patients prescribed the drugs. One wonders if perhaps the $13 billion per annum sales of PPIs could perhaps be behind such comments. A recent study found that people prescribed PPIs had a 25% higher risk of death over an 8 year period of study, with the risk increasing the longer the exposure (Xie etal, 2017).
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Xie etal, https://bmjopen.bmj.com/content/7/6/e015735
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