PPIs Increase Risks for Infection, Vitamin Deficiency

A new Mayo Clinic study published in Microbiome shows that patients with acid reflux who regularly receive proton pump inhibitors (PPIs) have less diverse gut bacteria, which heightens their risk for bone fractures, vitamin deficiencies, and infections such as Clostridium difficile and pneumonia.

“Evidence has been mounting for years that long-term use of proton pump inhibitors poses increased risks for a variety of associated complications, but we have never really understood why,” said senior study author and Mayo Clinic gastroenterologist John DiBaise, MD, in a press release. “What this study does for the first time is demonstrate a plausible explanation for these associated conditions.”

The gut microbiome assists in everything from digestion, to vitamin synthesis, to immune system regulation. However, decreased diversity in the microbiome caused by long-term PPI use can increase the risk of C. difficile infection, according to Dr. DiBaise.

“We’re not saying people should stop taking their regular antacids; despite the many health risks associated with PPI use, they have an extensive track record of safety when used as directed,” Dr. DiBaise said. “What we are saying is that the medical and research communities should consider these medications in the context of the patient’s microbiome. This is an area that needs further study.”

Thus far, the FDA has issued several safety communications concerning the use of PPIs, including long-term use at any dose. In addition, several clinical studies have linked PPIs to nutritional, metabolic, and infectious disorders.