Heartburn Drugs May Raise Pneumonia Risk12/20/10
MONDAY, Dec. 20 (HealthDay News) -- Popular heartburn drugs,
including proton pump inhibitors and histamine-2 receptor
antagonists, may raise the risk of pneumonia, new research
Researchers in Korea analyzed the results of 31 studies on
heartburn drugs published between 1985 and 2009.
"Our results suggest that the use of acid suppressive drugs is associated with an increased risk of pneumonia," said Dr. Sang Min Park of the department of family medicine at Seoul National University Hospital in Korea.
"Patients should be cautious at overuse of acid-suppressive drugs, both high-dose and long duration," he added.
Sales of these enormously popular drugs -- the second
best-selling category of medications worldwide -- reached nearly
$27 billion in the United States in 2005, according to background
information in the study, published Dec. 20 in
CMAJ (Canadian Medical Association Journal).
Proton pump inhibitors (PPIs) reduce acid production in the
stomach and are used to treat heartburn, gastroesophageal reflux
disease (GERD) and gastric ulcers. They include omeprazole
(Prilosec), lansoprazole (Prevacid) and esomeprazole (Nexium).
Histamine-2 receptor antagonists, often called H2 blockers, use
a different mechanism to reduce stomach acid and include cimetidine
(Tagamet), famotidine (Pepcid), nizatidine (Axid) and ranitidine
According to Consumer Reports, sales of a Nexium alone hit $4.8
billion in 2008.
Yet recently, studies have raised concerns about the drugs.
Several studies have linked PPIs to a higher risk of fractures and
an infection with a bacterium called
Some previous studies also linked heartburn drugs to a higher
risk of pneumonia, but the research has been mixed, according to
the study authors.
Their meta-analysis combined the results of eight observational
studies that found that taking PPIs increased the chances of
developing pneumonia by 27 percent, while taking H2 blockers
resulted in a 22 percent increased chance of pneumonia.
An analysis of 23 randomized clinical trials found people taking
H2 blockers had a 22 percent increased chance of getting
"Gastroenterologists in general have become more cognizant of the fact that these drugs can have some side effects," said Dr. Michael Brown, a gastroenterologist at Rush University Medical Center in Chicago. "For a long time, we were very happy to suppress people's acid without thinking about the consequences. Now we are starting to see some issues."
Hospital patients are often given acid-suppressing drugs, with
studies showing them prescribed to as many as 40 to 70 percent of
hospitalized patients. The authors suggest these drugs may be a
cause of hospital-acquired pneumonia.
The rationale is that patients in intensive care units have
decreased blood flow to the stomach, which can lead to ulcers and
bleeding, a life-threatening condition that PPIs can prevent, Brown
The problem is that many patients prescribed the drugs in the
hospital also go home with a prescription and continue taking PPIs,
perhaps unnecessarily, Brown said.
According to the study, one in every 200 inpatients treated with
acid-suppressing medications will develop pneumonia. The increased
risk isn't huge, but it's still meaningful, Brown said.
"These drugs are given out like candy. You are talking about very large numbers of people taking the drugs," Brown said. "The study found a moderate increase in pneumonia, but, given the very large numbers of people who use these drugs, it's very significant."
The most plausible reason why suppressing acid in the stomach
might raise the risk of pneumonia, Brown said, is that stomach acid
acts as a barrier helping to control harmful bacteria and
Not enough stomach acid to do the job may allow pathogens to
flourish and end up in the lungs.
Yet no one is questioning the importance of PPIs and H2 blockers
in treating GERD, said Dr. Jordan Josephson, an ear, nose and
throat doctor at Lenox Hill Hospital in New York City. Reflux is
painful and uncomfortable, and there's also debate among the
scientific community as to whether it might increase the risk for a
certain type of esophageal cancer. Research regarding the
connection has had mixed results.
Reflux can also cause acids from the stomach to get into the
airways and inflame the bronchial tubes, raising the risk of
infection, he said.
"Not taking your PPIs can raise risk of bronchitis, sinusitis and maybe pneumonia," Josephson said. "I have a lot of patients on PPIs and H2 blockers and have never seen any of them end up with pneumonia as a result."
U.S. National Digestive Diseases Information
Clearinghouse has more on GERD.
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