Acid Blockers Raise Risk of COVID-19, Other Diseases
Acid-reducing drugs, also called proton pump inhibitors (PPI), are one of the most successful drug classes ever launched, projected to earn as much as $3.26 billion in profits in the year 2026.
“Twenty-five years after their introduction into clinical practice, PPIs remain the mainstay of the treatment of acid-related diseases,” research published in the journal BMC Medical says. “Overall, PPIs are irreplaceable drugs in the management of acid-related diseases.”
Comprising both prescription and over-the-counter preparations, PPIs are intended to treat acid diseases such as gastroesophageal reflux disease or GERD (which stems from stomach acid repeatedly back flowing into the esophagus) as well as other conditions such as heartburn, stomach discomfort, and the risk of gastrointestinal bleeding in ulcer patients or those using blood thinners, such as aspirin. More than 15 million Americans have been prescribed PPIs prescriptions and many others buy the drugs over the counter.
But despite their popularity, questions remain about the drug class. According to 2018 research published in the Journal of Neurogastroenterology and Motility, “PPIs tend to be given for conditions in which the necessity of the drug has not been clarified” opening the door to such adverse effects, albeit rare, as:
- Allergic reactions
- Collagenous colitis
- Kidney harm
- Liver harm/infection of abdominal fluid
- Gastrointestinal infection
- Gastric tumors
- Gastric inflammation/ulcers
- Gastric polyps
- Colon cancers
- Intestinal bacterial overgrowth
- Decreased absorption of nutrients
The dementia risk of PPIs attracted attention in 2016 when an observational study by German researchers was published in JAMA Neurology. It linked regular PPI use with a 44 percent increased dementia risk compared to people not using the drugs.
The study was based on the medical records of 73,679 people ages 75 and older.
Research published in the journal Expert Review of Clinical Pharmacology elaborates on and adds to the possible PPI risks:
“The risk of pneumonia [from PPI use] was increased 27-39 percent in short-term use of PPIs in three meta-analyses,” the researchers wrote. “C. difficile infections [a serious intestinal parasite] were also associated with the use of PPIs,” as were thrombocytopenia (low blood platelet count), rhabdomyolysis (muscle damage and degradation), and nephritis (inflammation of the kidneys).
The U.S. Food and Drug Administration (FDA) is aware of the risks, which grow with long-term usage. According to U.S. Pharmacist, “Since 2010, the FDA has issued various safety warnings regarding the potential effects of long-term use of PPIs,” not just the adverse events listed by the Journal of Neurogastroenterology and Motility, but also PPI-linked risks of fractures, clostridium difficile-associated diarrhea, and lupus-related events.
“Although proton pump inhibitors (PPIs) remain the primary treatment of GERD, they do not cure the disorder and can leave patients with persistent symptoms despite treatment,” Physician’s Weekly adds. Nor are patients immune from other conditions, the publication says, noting that “patients are still at risk of developing such complications as peptic strictures, Barrett’s metaplasia, and esophageal cancer.”
Because the drug class is intended to be used for the shortest time possible, the journal Gastroenterology warns that “patients with uncomplicated GERD who respond to short-term PPIs should subsequently attempt to stop or reduce them. Patients who cannot reduce PPIs should consider ambulatory esophageal pH/impedance monitoring [measuring the amount of acidic and non-acidic reflux in the esophagus during a 24-hour period] before committing to lifelong PPIs to help distinguish GERD from a functional syndrome.”
A Drug Class With Strengths and Weakness
Certainly, acid-related conditions, such as when excess acid appears in the wrong place, occur and are uncomfortable. Such occurrences are “a menace, inflaming and irritating the esophagus, typically causing heartburn and sometimes contributing to the development of ulcers in the stomach and the duodenum, the first part of the small intestine,” Harvard Health explains.
And yet, the potential long-term side effects revealed by researchers and health agencies raise the question of whether the medications are overprescribed.
“Taking a PPI makes sense if you have a chronic problem with stomach acid or the prospect of one developing,” Harvard Health says. “But the occasional case of mild heartburn does not need to be treated with a PPI. For that kind of spot duty, the old standbys of antacid medicine like Tums, Rolaids, and Maalox will most likely work just as well.”
Cedars-Sinai, a nonprofit academic health care organization, points out that taking an acid blocker doesn’t address other GERD causes such as “being overweight, overeating, having caffeine and alcohol, and eating chocolate and spicy foods.”
“This condition causes rebound hyperacidity; after discontinuing PPI therapy, patients may experience worsening GERD symptoms,” the publication says. “To avoid this, PPIs should be slowly tapered. In addition, hypergastrinemia can cause parietal cells to hypertrophy and enterochromaffin-like cells (ECL) [gastric secreting cells] to undergo hyperplasia.”
PPIs Linked to Contracting COVID-19
Because our stomach acid protects us from a lot of viruses and bacteria, some people, especially those in the medical field, weren’t too surprised when PPIs were linked to a greater risk of contracting COVID-19 when the pandemic began.
In 2020, the journal American Journal of Gastroenterology published a study from researchers affiliated with Cedars-Sinai Medical Center and Michigan Medicine that discussed the link.
“In a nationwide study of individuals with a history of GI symptoms, we found that the use of PPIs is associated with increased odds for reporting a positive COVID-19 test. The highest risk is seen among individuals taking PPIs twice daily—a common off-label practice in both primary and secondary care—because they are nearly 4-times more likely to report COVID-19 positivity when compared with those not on PPIs.”
Dr. Brennan Spiegel, one of the researchers and the study’s guarantor (a research author responsible for the integrity of the work as a whole) told Time: “Viruses like SARS-CoV-2 are capable of hijacking the gastrointestinal tract quickly. … It can invade, replicate and multiply efficiently. There is even a theory that maybe it uses the intestines as a kind of home base where it entrenches itself and then spreads throughout the body.”
The following year, the journal Gut reported related research. In a cohort of more than 100,000 PPI users, non-users, and previous users, the PPIs weren’t linked with a higher risk of catching COVID-19 but PPI users experienced “a 79 percent greater risk of severe clinical outcomes of COVID-19,” the journal stated. While the potential risks of PPIs were identified long before COVID-19, the pandemic clearly added to questions.
Alternatives to PPIs
Are there any herbs that can help reduce stomach acid? Yes, according to research published in 2019 in the journal Current Gastroenterology Reports.
“With emphasis on reflux and non-cardiac chest pain, research is ongoing into the clinical utility and diverse physiologic mechanisms underlying a variety of complementary and alternative modalities,” wrote researchers associated with Thomas Jefferson University and the University of Pennsylvania.
The complementary and alternative modalities include “dietary manipulation, apple cider vinegar, melatonin, acupuncture, and various herbal products (rikkunshito, STW 5, slippery elm, licorice, and peppermint oil, among others).” While the researchers acknowledge a “substantial gap” between “anecdotal and empirical” knowledge of non-pharmacologic remedies for acid diseases, it also calls opportunities for future research “compelling.”
Finally, Johns Hopkins Medicine reminds people to steer clear of certain foods associated with an acid reaction such as:
- Fried food
- Fast food
- Potato chips and other processed snacks
- Chili powder and pepper (white, black, cayenne)
- Fatty meats such as bacon and sausage
- Tomato-based sauces
- Citrus fruits
- Carbonated beverages