Proton Pump Inhibitors, Other Heartburn Drugs Linked to Recurrent C. Diff Infections

Published on March 31, 2017 by Sandy Liebhard

People who use proton pump inhibitors or other heartburn medications may be more likely to experience multiple Clostridium difficile infections. The authors of a study published this month in  JAMA Internal Medicine are now suggesting that doctors re-evaluate the use of acid suppressing drugs in patients with a history of the infection.

What is C. Diff?

Clostridium difficile, or C. diff, can cause diarrhea and life-threatening inflammation of the colon. The so-called “superbug” affects about a half million U.S. patients annually, and has become more difficult to treat in recent years. Older adults in hospitals or nursing homes – especially those treated with antibiotics – are most likely to develop C. diff. However, some studies indicate that the infection is occurring more frequently in younger adults without any of these risk factors.

Recurrent C. diff – in which the infection returns over time — has become a significant problem. In fact, people who have experienced three or more infections face a 50% to 60% risk of recurrence.

What Did the Study Conclude?

This new research involved a meta-analysis of 16 previous studies that included more than 7,700 patients with C. diff. Overall, 19.8% of those patients experienced recurrent infections. However, 22.1% of those taking heartburn drugs – either proton pump inhibitors or H2 blockers – reported recurrence. By contrast, only 17.3% of patients who weren’t taking the medications had recurrent infections.

“Meta-analyses of observational studies suggest that patients who receive gastric acid suppressants may be at increased risk for recurrent CDI,” the study authors concluded. “These data should be interpreted with caution because they may be confounded owing to the observational design of the individual studies. It may be reasonable to re-evaluate the need for these medications in patients with CDI.”

In 2012, the U.S. Food & Drug Administration (FDA) warned of a potential link between proton pump inhibitors and C. diff-associated diarrhea. The agency suggested that doctors consider this diagnosis in patients taking proton pump inhibitors if they develop diarrhea that does not improve.

Proton Pump Inhibitors and the Kidneys

Proton pump inhibitors are sold in both prescription and over-the-counter versions, and include popular brand-name drugs like Nexium, Prilosec and PrevAcid. In 2013, more than 15 million Americans used prescription proton pump inhibitors to treat GERD and other peptic disorders. However, it has been estimated that between 25% and 70% of these prescriptions have no appropriate indication.

The C. diff study isn’t the first to indicate that proton pump inhibitors may be associated with significant side effects. For example, multiple studies published over the past few years have suggested that long-term treatment with these drugs may result in serious kidney complications:

• A study published in CMAJ Open in April 2015 indicated that patients taking proton pump inhibitors faced a 3-fold increase in the risk for acute interstitial nephritis, as well as a 2.5 times higher risk of acute kidney injury.
• A paper published in the January 2016 issue of JAMA Internal Medicine suggested that proton pump inhibitors might increase the risk of chronic kidney disease by as much as 50%.
• In April 2016, research that appeared in the Journal of the American Society of Nephrology linked long-term proton pump inhibitor use to a 96% increase in the likelihood of kidney failure and 28% increased risk for chronic kidney disease in comparison to H2-blockers.
• This past February, a study that appeared in Kidney International indicated that proton pump inhibitor users who do develop chronic kidney disease may not experience any acute renal symptoms until the disease has progressed to an advanced stage.

Over the past year, a growing number of plaintiffs have filed kidney damage lawsuits against the drug companies that market Nexium and other proton pump inhibitors, accusing them of concealing the renal risks associated with their products. Last month, a  judicial panel refused to consolidate all federally-filed claims of this nature in a single U.S. District Court for coordinated pretrial proceedings. However, proton pump inhibitor lawsuit filings continue to mount, and cases are moving forward in courts around the country.