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Commonly prescribed heartburn drug linked to pneumonia in older adults

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Proton-pump inhibitors, commonly used to neutralise stomach acid in people with heartburn or stomach ulcers, are linked to an increased risk of pneumonia in older patients, warn researchers.

A new UK study, published in the Journal of the American Geriatrics Society, has found a statistical link between pneumonia in older people and the group of medicines.

“We have demonstrated for the first time a clear increase in long‐term pneumonia incidence”

Study authors

Researchers said that, while proton-pump inhibitors (PPIs) were still a valuable group of medicines, research was now indicating that PPIs were not as completely safe for older people as once thought.

Once thought to be relatively harmless, PPIs have more recently been linked to increased rates for certain health concerns like fractures, cardiovascular disease, and some bacterial infections.

The Exeter University team said they studied PPI use and pneumonia because stomach acid was a barrier to infections spreading from the gut in people with stomach reflux.

Since pneumonia was a major cause of death in this country for older adults, it was important for healthcare providers to understand the links between PPIs and pneumonia, they highlighted.

To investigate if there was a connection, the researchers identified more than 75,000 adults aged over 60 who were treated with PPIs for one year or more and matched them against controls.

They concluded that pneumonia risk was greater with long‐term PPI therapy in older adults in primary care, independent of excess pneumonia rates immediately before first receiving a PPI.

“Our study adds to growing evidence that PPIs are not quite as safe as previously thought”

David Melzer

They noted that previous research suggested that around 40% of older adults received PPIs, although up to 85% of people who received PPI prescriptions may not actually need them.

The researchers recommended that prescribers and patients should discuss whether PPIs were still needed.

“We have demonstrated for the first time a clear increase in long‐term pneumonia incidence associated with ongoing PPI use after accounting for preexisting differences in pneumonia rates between treated and control groups,” said the study authors.

“Although the number needed to harm was relatively large – 420 participants for 12 months – given the high prevalence and frequent continuation of PPIs without good indication, this number needed to harm represents a significant risk to older adults,” they said.

Author Professor David Melzer, from the University of Exeter Medical School, said: “This study shows that there was a higher rate of pneumonia in older people who received PPIs over a two-year period.

“Caution is needed in interpreting the findings as our study is based on analyzing data from medical records, so other factors may be involved,” he said.

“However, our study adds to growing evidence that PPIs are not quite as safe as previously thought, although they are still a very useful class of medication for certain groups of patients,” he added.

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