MedicalResearch.com Interview with:
Ziyad Al-Aly, MD, FASN
Assistant Professor of Medicine
Director of the Clinical Epidemiology Center
Chief of Research and Education
Department of Veterans Affairs Health Care System
MedicalResearch.com: What is the background for this study?
Response: In 2017, we published a paper showing increased risk of death associated with Proton-pump inhibitors (PPI) use. Following the publication of that 2017 paper, several key stakeholders including patients, doctors, research scientists, medical media folks, mainstream media folks, and others asked us: what do these people die from? Did you study causes of death attributable to PPI use? In the study published today, we developed a causal inference framework to answer this question.
MedicalResearch.com: What are the main findings?
Response: We found that PPI use is associated with increased risk of death due to cardiovascular disease, chronic kidney disease, and upper gastrointestinal cancer. The risk was evident in people taking PPIs but who had no documented medical indication (no need) for being on PPI. Most of the people were on prescription PPI doses that were equivalent to over the counter doses.
MedicalResearch.com: What should readers take away from your report?
Response: Proton-pump inhibitors use and overuse may not be devoid of harm. Over the counter use should be limited to 14 days or less. Physicians should prescribe PPI only when necessary, and limit dose and duration to minimum necessary. Physicians should evaluate need for PPI in their patients, and deprescribe when not necessary.
MedicalResearch.com: What recommendations do you have for future research as a result of this work?
Response: There is a lot of Proton-pump inhibitors overuse, and we have to figure out how to design, and implement de-prescription strategies to curb overuse of PPI, and to help patients who do not need to be on PPI get off these medications.
Xie Yan, Bowe Benjamin, Yan Yan, Xian Hong, LiTingting, Al-Aly Ziyad et al. Estimates of all cause mortality and cause specific mortality associated with proton pump inhibitors among US veterans: cohort study BMJ 2019; 365 :l1580
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