Is It Risky to Take Heartburn Medication?

Heartburn medications can work wonders when it comes to alleviating the painful burning sensation in the chest and throat caused by acid reflux, a condition that affects over 60 million Americans each month. But research has linked a common class of heartburn drugs, called proton pump inhibitors (PPIs), to potential health risks — especially when these medications, often meant for short-term use, are taken for a long time.

That’s not an uncommon scenario, health experts say. “Oftentimes patients come into the hospital, they get put on a PPI and then it just never leaves their [medication] list,” says Shawna Stricker, a pharmacy resident at Nebraska Medicine in Omaha. (PPIs — which include lansoprazole [Prevacid], omeprazole [Prilosec] and esomeprazole [Nexium] — are also available over the counter.) The question then becomes: Does the patient “actually need that anymore, or is it causing more harm than good?” Stricker says.  

Health risks associated with PPIs

While PPIs are generally considered safe, researchers have uncovered some potential health risks associated with long-term use of the pills. 

For example, a recent study published in the journal Neurology suggests that people who take a prescription PPI for more than four years may have a higher risk of developing dementia compared to people who don’t take these medications. 

The study, which did not look at risks associated with over-the-counter PPI medications, included 5,712 adults ages 45 and older. Researchers followed the adults an average of five and a half years and observed that those who had been taking the acid reflux drugs for more than 4.4 years had a 33 percent higher risk of developing dementia than people who never took the drugs. (It’s important to note, however, that most studies have not found an association between PPI use and dementia among older adults.)

Beyond dementia, previous research has linked long-term PPI use to increased risk of bone fracture, kidney disease, gastrointestinal infection and magnesium deficiency. These risks were most pronounced in older adults, many of whom take medication for heartburn.

What’s the link?

Why taking proton pump inhibitors might be linked in some way to a higher risk of dementia or other health issues isn’t entirely clear, but researchers have some theories.

There could be a number of reasons that explain the higher dementia risk in people taking PPIs, says Kamakshi Lakshminarayan, M.D., a professor in the School of Public Health at the University of Minnesota and senior author on the Neurology paper.

She stresses that the study she led was observational — meaning it doesn’t confirm cause and effect — and the researchers couldn’t rule out other contributors to dementia. “This study does not prove that acid reflux drugs cause dementia; it only shows an association,” Lakshminarayan notes. That said, low vitamin B12 levels could have something to do with it.

Other research finds that having lower levels of stomach acid from taking PPIs reduces the body’s ability to release B12 from foods, meaning less gets absorbed. And low B12 levels can affect memory and thinking skills, Lakshminarayan explains. (The researchers, however, didn’t measure participants’ initial B12 levels, so they couldn’t say if a decrease in those levels factored into the link they found between long-term PPI use and a higher risk of dementia.)

As far as other health issues go, reduced absorption of calcium could be to blame for possible fracture risks associated with PPIs, and alterations in the gut could be behind the increased risk for gastrointestinal infections, research suggests.

Concerned? Talk to your doctor

Lakshminarayan, Stricker and other researchers stress that studies to date don’t prove that heartburn medicines cause the health problems to which they’re linked. Instead, the studies are primarily observational, meaning researchers have observed that people who take the drugs continuously have a higher incidence of certain health problems, ranging from infection to dementia.

Still, the research available “raises concern,” says Kristina Thurber, a clinical pharmacist at Mayo Clinic who has studied PPI and health risks. 

If you’re taking a PPI, and have been doing so for a while, talk to your doctor about whether it’s something you still need to take. The benefits may outweigh any potential risks — not to mention it can be risky to stop taking PPIs on your own if the medication was prescribed to treat an ulcer. But there are also cases where doctors should be deprescribing PPIs, says Marcel Yibirin, M.D., an internal medicine resident at Boston Medical Center.

Yibirin stresses that patients on PPIs should take the “lowest effective dose for the shortest duration of time” needed. The problem, he adds, is that patients can access the medications over the counter, and many take them without being monitored on an ongoing basis by a doctor.

If you and your health care provider decide you don’t need a PPI, know that antacids (Tums, for example) can help treat mild heartburn. Lifestyle changes such as losing weight, altering your diet, adjusting medication regimens (again, talk to your doctor) and switching up your sleeping position can also help.