New Study Finds PPIs Increase Risk For C. Diff

Popular heartburn medications, <"">Proton Pump Inhibitors (PPIs), have been linked to more adverse reactions; this time, Clostridium difficile (C. diff), in a large Japanese study presented at the annual Interscience Conference on Antimicrobial Agents and Chemotherapy.

We recently wrote that PPIs increase the risk for several serious conditions, including fractures of the hip, spine and wrist; an increased risk of serious infections such as pneumonia and C. difficile diarrhea; and severe magnesium deficiency, which can cause life-threatening cardiac arrhythmias. While these and other serious side effects are listed in the fine print of the drugs’ labels, none are given prominence via a black box warning. Because of this, many physicians may not be aware of the serious risks associated with PPI therapy.

The recent study found that C. diff-associated disease was found to be over three times higher in people taking PPIs versus those not taking the medications, Family Practice News Digital Network wrote. “In addition to previous use of antimicrobials, long-term use of proton pump inhibitors [PPIs] is pointed out as a risk factor” of C. difficile–associated disease (CDAD),” said the researchers, led by Dr. Takatoshi Kitazawa.

Dr. Kitazawa of Teikyo University, Tokyo, and his associates reviewed medical records for 793 patients admitted to the university’s department of medicine between April and June of 2009, said Family Practice News. PPI users were defined as patients prescribed a PPI in excess of 30 days and CDAD was defined as detection of C. diff toxin retrieved from stool samples in diarrhea patients, explained Family Practice News. Immunosuppressant use involved taking over 20 mg of prednisolone and other agents in this drug class in excess of 30 days; a long hospital stay constituted a stay in excess of 30 days, Family Practice News added.

Last year, we wrote that another study suggested that taking PPIs could increase risks for CDAD by upwards of 80%. As we noted, C. difficile represents an escalating threat to public health, and CDAD cost the U.S. an estimated $3 billion in 2005.

Proton pump inhibitors include prescription and over-the-counter (OTC) drugs including Nexium, Dexilant, Prilosec, Prilosec OTC, Zegerid, Zegerid OTC, Prevacid, Prevacid 24-Hr, Protonix, Aciphex, and Vimovo and are approved to treat gastroesophageal reflux disease (GERD)—sometimes referred to as acid reflux—as well as gastric ulcers, erosive esophagitis, and stomach bleeding associated with using non-steroidal anti-inflammatory drugs. Since their introduction in the 1990s, PPIs have ranked among the top-selling drugs, with doctors writing 119 million prescriptions for them last year alone.

Most recently, consumer watchdog, Public Citizen, petitioned the U.S. Food & Drug Administration (FDA) to require that manufacturers list serious adverse reactions associated with PPIs in a prominent black box warning on their labels. According to the group, evidence shows that after using PPIs for a month or more, patients who stop taking the drug make even more stomach acid than before they started, a phenomenon known as rebound acid hypersecretion. This causes acid reflux symptoms to return even worse than before therapy, and patients begin taking the drugs again, leading to long term dependency.

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