A series of studies conducted by University of California San Diego researchers suggest that proton pump inhibitors like Nexium may be contributing to the rising incidence of chronic kidney disease.
The research, which appears in Nature Communications, involved mouse models, healthy human volunteers, and data from chronic alcoholics.
The mouse models were used to study the effect of proton pump inhibitors on three types of liver disease: alcoholic liver disease, non-alcoholic fatty liver disease (NAFLD), and non-alcoholic steatohepatitis (NASH).
For the first study, the researchers blocked gastric acid production in mice either with genetic engineering or with Prilosec. They then sequenced microbe-specific genes collected from the animals’ stool to compare the gut microbiome in mice that had undergone acid suppression and those that had not.
“The researchers found that mice with gastric acid suppression developed alterations in their gut microbiomes. Specifically, they had more Enterococcus species of bacteria,” a press release from UC San Diego noted. “These changes promoted liver inflammation and liver injury, increasing the progression of all three types of liver disease in the mice: alcohol-induced liver disease, NAFLD and NASH.’
For the second study, the research team colonized mice with Enterococcus faecalis to mimic the overgrowth of intestinal enterococci. The experiment confirmed that increased Enterococcus alone was sufficient to induce mild steatosis and increase alcohol-induced liver disease in mice.
Finally, to examine the link between proton pump inhibitor usage and alcoholic liver disease among alcohol abusers, the group analyzed data involving 4,830 patients with a diagnosis of chronic alcohol abuse, including 1,024 (21 percent) active proton pump inhibitor users, and 745 (15 percent) previous users and 3061 (63 percent) who had never used proton pump inhibitors.
Patients who were taking proton pump inhibitors had higher stool concentrations of Enterococcus. What’s more, the rate of liver disease in people who chronically abuse alcohol was 8.3 percent higher for those who actively use proton pump inhibitors compared to those who never used the acid-blocking medications.
“Our findings indicate that the recent rise in use of gastric acid-suppressing medications might have contributed to the increased incidence of chronic liver disease,” the study’s lead author said. “Although obesity and alcohol use predispose a person to acid reflux requiring antacid medication, many patients with chronic liver disease take gastric acid suppressive medications without appropriate indication. We believe clinicians should consider withholding medications that suppress gastric acid unless there is a strong medical indication.”
Proton pump inhibitors like Nexium, Prilosec and Prevacid are prescribed to more than 15 million Americans every year to prevent GERD and other problems associated with the excess production of gastric acid. However, several studies have suggested that proton pump inhibitors are often overprescribed and that many people are taking them inappropriately.
Because they are so popular, many patients wrongly-believe that proton pump inhibitors come with few, if any, risks. However, recent studies have linked the drug to several serious side effects, bone fractures, heart attacks, and dementia.
Most recently, research has linked long-term proton pump inhibitor treatment to kidney failure, chronic kidney disease, acute kidney injury, and acute interstitial nephritis. In fact, hundreds of proton pump inhibitor lawsuits have been filed in U.S. courts on behalf patients who claim the drugs harmed their kidneys and who accuse the manufacturers of Nexium, Prilosec and Prevacid of failing to provide doctor and patients with adequate safety warnings.