Popular heartburn medications associated with stroke: Should you be concerned?


by Dr. Terilyn Scott-Winful

Feb 2, 2017

Heartburn can be a pain, especially following the holiday season.

To find relief, millions of Americans have relied on a class of drugs called Proton Pump Inhibitors (PPIs)—medications that bind to stomach cells to reduce acid, often associated with conditions such as gastroesophageal reflux disease (GERD) and ulcers.

But a new study casts doubt on the safety of the class of drugs.

Presented at the American Heart Association’s Scientific Sessions 2016, researchers found that patients taking PPIs had a 21 percent increase of having a first-time ischemic stroke, a common type of stroke that is caused by a blocked artery.

While that statistic can be frightening for patients on the medication, the retrospective study only established an association between stroke and PPI use, but did not determine direct causation. This means that more conclusive studies are needed to confirm the findings.

If anything, this new information will help physicians make decisions about prescribing PPIs and whether it’s necessary for certain patients to remain on them.

So, in the meantime, how should patients interpret this information? And when do the potential risks outweigh the benefits?

Evaluating PPI use

In recent years, additional observational studies have questioned the safety of PPI use, linking it to greater risk of dementia and heart attacks. Using data mining techniques, researchers combed through data to look for associations with negative outcomes, but have not studied the outcomes in depth to determine definitive causes.

With any medication, we must figure out if patients need to take them, and if so, for how long. This can be achieved by performing a risk assessment on patients before prescribing PPIs.

If there are more risks than benefits, alternative medications, such as H2 blockers or even over-the-counter antacid medications should be considered.

But more importantly, I evaluate if certain lifestyle factors are leading to heartburn. I encourage patients to avoid food triggers and propose weight loss to minimize the symptoms that PPIs are designed to treat.

While the risk of PPIs is high for certain patients, for others, it is not. Patients with conditions such as Barrett’s esophagus and gastric ulcers rely on PPIs, as the medications protect the gastrointestinal tract and their overall health.

How to talk with your doctor

While new guidelines on the use of PPIs have yet to be issued, I recommend talking with your doctor to determine the necessity of PPI use.

Here’s how to start the conversation:

  • Communicate your concerns with your primary care physician before your next appointment to make the most of a wellness check up
  • Ask your doctor to evaluate your risk for stroke
  • Have your doctor perform a risk-benefit analysis of PPI use
  • Consider alternative medications such as H2 blockers, if your risk for stroke is high

And of course — with the help of your physician —look to reduce lifestyle factors that are likely heartburn culprits.

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