The therapeutic value of a drug is measured by its benefit/harm ratio. We have to be very careful about drugs with a low rate. Sometimes the adverse effects (harmful side effects) of the drugs we use can be more important than their therapeutic (therapeutic) effects. Research on side effects begins during drug development, continues during and after clinical practice. Drugs are prescribed considering the benefit/harm ratio according to the data obtained from these studies.
For example, proton pump inhibitors, which are frequently used due to ulcers, gastritis, etc., are prescribed by the doctor to be used for two weeks. Those with reflux disease are advised to take these drugs continuously. Although short-term use of proton pump inhibitors (PPIs) is considered safe, there is ongoing debate about their long-term use. Recent research shows that chronic (continuous) use of PPIs may be linked to possible Alzheimer’s disease, heart and kidney problems.
PPIs reduce acid in the stomach by shutting down many of the cellular pumps that pump out hydrogen ions or protons, localized in the lining of the stomach, thereby allowing reflux into the esophagus. The closure is permanent, but since the cellular pumps are regenerated, these drugs reduce symptoms (complaints), not curative (curative). On the other hand, the decrease in stomach acid causes insufficient absorption of various vitamins and minerals such as B12 and related diseases and bone loss. It is suggested that a decrease in vitamin B12 increases the risk of Alzheimer’s disease and dementia due to the fact that the brain is more vulnerable to damage. Recent findings show that patients on chronic PPIs have an increased (44%) risk of dementia and the production of beta-amyloid proteins, a hallmark of Alzheimer’s, independent of stomach acid. Similarly, kidney disease is twice as common in people taking PPIs than in the general population. Moreover, the risk rate is higher for those who use a double dose of PPI every day than for those who use a single dose.
Studies at the cellular level show that PPIs affect the acid content of cells in the stomach as well as some blood vessel cells. As with many cells in the body, cells in blood vessel walls produce acid to get rid of abnormal or damaged proteins and expel them from the cell. If the acid level of the cell is too low, these microscopic damaged particles begin to accumulate inside the cell and the cell cannot function properly. Accumulation of protein residues leads to increased oxidative stress, endothelial dysfunction, and aging. Therefore, it has been suggested that long-term use of PPIs may cause problems wherever there are blood vessels, such as in the brain and kidneys. All these data show us that PPIs can cause an increased risk of cardiovascular morbidity (disease rate) and mortality (death rate), kidney failure and dementia etc.
Many doctors worry that reports of potential side effects will frighten patients who actually need the medication. However, it would be appropriate for doctors to review new findings before deciding on PPIs used by millions of people today in untested and unapproved indications and durations other than reflux, ulcer, gastritis, etc.
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Lazarus B, Chen Y, Wilson FP, Sang Y, Chang AR, Coresh J, et al. Proton pump inhibitor use and the risk of chronic kidney disease. JAMA Intern Med 2016; 176:238–46
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