Proton pump inhibitors associated with excessive death risk, study says — AGA responds

A study, published in BMG Open, examined proton pump inhibitor use and associated death risk.

Yan Xie, PhD, of the VA Saint Louis Health Care System, and colleagues conducted a longitudinal observational cohort study using administrative data from the U.S. Department of Veterans Affairs. Researchers followed 349,312 new users of PPIs or histamine H2 receptor antagonists for a median of 5.71 years.

Additional subject groups included PPI users versus no PPI users (3.2 million subjects) and PPI users versus no PPI and no H2 blocker users (2.8 million subjects).

Here's what they found:

1. PPI use increased risk of patient death compared to patients only on H2 blockers.

2. PPI users had a higher death risk in analyses adjusted for "high-dimensional propensity scores in two-stage residual inclusion estimation and in one-of-one time-dependent propensity-score matched cohorts."

3. PPI users without gastrointestinal diseases had a higher death risk, as well.

4. Researchers established a graded association between exposure duration and risk of death.

Researchers concluded, "The results suggest excess risk of death among PPI users; risk is also increased among those without gastrointestinal conditions and with prolonged duration of use. Limiting PPI use and duration to instances where it is medically indicated may be warranted."

The American Gastroenterological Association released a conversation guide for providers on the new study.

The organization said providers should reassure patients that while the research could be frightening, the study, "still indicates that those who have a diagnosed condition that is helped by PPIs should stay on them, as benefits can outweigh those risks."

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