In the world, around 10% of the general population take a proton pump inhibitor (PPI) drug to treat symptoms of frequent heartburn, acid reflux, and gastroesophageal reflux disease.
A recent study from University of California San Diego shows that PPIs block stomach acid secretions and can be harmful.
This could alter specific gut bacteria and promotes liver injury and progression of the chronic liver disease.
Liver cirrhosis is the 12th leading cause of death worldwide and the number of people with the chronic liver disease is increasing rapidly in many Western countries.
The increase is partly because more people have obesity, which is associated with non-alcoholic fatty liver disease (NAFLD) and steatohepatitis (NASH).
Another reason is alcohol abuse.
PPIs, which include brand names such as Prilosec, Nexium, and Prevacid, are among the most commonly prescribed drugs in the world.
They are also relatively inexpensive medications, retailing for approximately $7 for a recommended two-week course of generic, over-the-counter Prilosec (omeprazole).
But the frequency of use adds up — one study estimates Americans spend $11 billion on PPIs each year.
Previous research has shown that PPIs usage is particularly common among people with the chronic liver disease.
To determine the relationship between PPI usage and chronic liver disease, the team looked at mouse models that mimic alcoholic liver disease, NAFLD and NASH in humans.
In each, they blocked gastric acid production either by genetic engineering or with a PPI (omeprazole/Prilosec).
The researchers found that mice with gastric acid suppression developed alterations in their gut microbiomes.
These changes promoted liver inflammation and liver injury, increasing the progression of all three types of liver disease: alcohol-induced liver disease, NAFLD and NASH.
The team also examined the link between PPI usage and alcoholic liver disease among people who abuse alcohol.
They analyzed data of 4,830 patients with a diagnosis of chronic alcohol abuse — 1,024 (21%) were active PPI users, 745 (15%) were previous users and 3061 (63%) had never used PPIs.
The researchers noted that PPI intake among these patients increased stool concentrations of Enterococcus.
What’s more, the 10-year risk of a diagnosis of alcoholic liver disease was 20.7% for active users of PPIs, 16.1% for previous users and 12.4% for never users.
The researchers concluded that there is an association between PPI use among people who abuse alcohol and risk of liver disease.
They suggest that a large, randomized, controlled clinical trial would be needed to definitively show causality between PPI usage and risk of chronic liver disease in humans.
There are inexpensive and readily available alternatives to PPIs.
However, even non-PPI-based antacids (e.g., Pepto-Bismol, Tums, or H2 blockers such as Tagamet and Zantac) still suppress gastric acid to a lesser degree.
While these other types of antacids were not tested in this study, the team said any medication that suppresses gastric acid effectively could cause changes in gut bacteria and thus potentially hurt the liver.
Alternatively, non-pharmacological methods for managing heartburn are an option for some patients, including losing weight and reducing intake of alcohol, caffeine, and fatty and spicy foods.
The study is published in Nature Communications.
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