PPIs are one of the prescribed medications in Australia but the concerns are escalating. Not just from a naturopathic or nutritional perspective regarding the extraordinary concept of lowering gastric HCl by approx. 80% but much much more worrying concerns. I talked about some of these back in 2014, I remember making an executive decision at the time not to mention concerns that their long term use produced higher rates of gastric cancer, that even conservative medical news-feeds were starting to mention… I didn’t want to be alarmist. But the mechanism for this correlation is highly plausible – PPIs only inhibit acid production but they do not control the gastrin release by these cells and in fact the gastrin release rises with their use…and guess what gastrin is a trophic agent, it stimulates growth in the stomach and in other tissues.
“PPIs inhibit acid secretion, leading antral G cells to release gastrin, causing hypergastrinemia. Gastrin, in turn, binds to gastric mucosal ECL cells, causing them to release chromogranin, histamine and other substances. The acid-secretory effects of gastrin are inhibited by PPI, but the potential proliferative effects on mucosal cells or cancers are not. In most patients, PPI-induced elevations in serum gastrin are moderate (50–400 pg/ml) and normalize when the drug is stopped. However, in some patients (mostly those with H. pylori infection and atrophic gastritis), plasma levels can rise to between 400 and 4000 pg/ml. The trophic, concentration-dependent effects of gastrin are exerted at much lower concentrations, above 40 pg/ml.” https://www.medscape.com/viewarticle/730747_6
The same message, with more shocking data and therefore getting more airtime, has hit the news again this week, with the key headline that PPI use translates to a 2.4 times greater risk of gastric cancer & daily use 4.55 X risk compared with weekly use . Of course there is also criticism of this new research and suggestions that its findings might not apply to non-Asian populations, or that PPI users have other dietary and lifestyle risks that increase their rates of cancer independent of the PPI itself but at the very least I think we need to consider the hypergastrinemia – start measuring is…YES! why not? Then we can actually quantify the level of risk each PPI user faces and make a more informed risk benefit assessment. Perhaps it might also get more patients thinking, most of whom have come to view PPIs as ‘normal’, as just a more effective ‘Quick eze’ and who should understand the gravity of their choice to use this, typically daily and typically for decades.
Anyway…just thought, after keeping ‘mum’ about this in 2014, it’s come back to bite me on the butt…it’s time to raise the alarm.
Oh…and PPIs though often mistakenly prescribed for ‘silent reflux’ which I described recently…don’t work…so that’s 2 really good reasons not to use them in those patients! But you can find some good solutions by listening to the latest UU30: Chronic dry coughs, rhinitis, postnasal drip, the sensation of ‘a lump in their throat’ or even asthma? Have you ruled out silent reflux aka laryngopharyngeal reflux? Download the latest UU30 to get up to speed with this prevalent condition or become a subscriber today and get this installment and another one every month for the year!