PPIs and Liver Disease: PPIs Increase the Progression of Liver Disease. Not only does alcohol damage your liver. Your heartburn medication may be damaging it too.Not only does alcohol damage your liver. Your heartburn medication may be damaging it too. Through a series of studies, researchers at UC San Diego Medical Center have proven an association between liver damage in those who have an existing liver disease and highly popular heartburn medications know as proton pump inhibitors (PPIs).

Alcohol causes numerous health issues. One such issue is heartburn caused by acid reflux. Alcohol will cause the lower esophageal sphincter (LES) to relax. The LES is a ring of muscles at the base of the esophagus that closes to keep stomach acids in the stomach and out of the esophagus. The stomach has a protective lining that insulates it from stomach acid. The esophagus does not. When the LES relaxes, stomach acid leaks back into the esophagus and causes the irritation and pain we know as heartburn. Chronic acid reflux, reflux that occurs a few times a week, is called gastroesophageal reflux disease (GERD). For this reason, a high majority of alcoholics have GERD.

Tens of millions of people take PPIs daily to control acid reflux and GERD. They are the strongest acid suppressor and one of the most popular classes of heartburn medication on the market.

Do you take any of these PPIs as either their brand names or generic?

  • AcipHex (rabeprazole)
  • Dexilant (dexlansoprazole)
  • Kapidex (dexlansoprazole)
  • Losec (omeprazole)
  • Nexium (esomeprazole)
  • Prevacid (lansoprazole)
  • Prilosec (omeprazole)
  • Protonix (pantoprazole)
  • Rapinex (omeprazole)
  • Vimovo (esomeprazole, magnesium, and naproxen)
  • Zegerid (omeprazole and sodium bicarbonate)

PPI Side Effects

According to the U.S. Food and Drug Administration (FDA), PPIs are to be used for the short-term and are safe when used properly. They are not typically recommended for long-term use and should not be used for the long-term without being under a doctor’s supervision. For that matter, PPIs should not be used unless prescribed by a doctor. Many people take this heartburn medication when safer medications are available. Medications that don’t have the same damaging side effects. Long-term PPI use has been linked to stroke, heart attack, kidney disease, dementia, bone fractures, pancreatic cancer, liver disease, and premature death.1,2

PPIs and Liver Damage in Alcoholics

Bernd Schnabl, MD, senior author of the study along with his research team at the University of California San Diego School of Medicine found that the absence of gastric acid through the use of PPIs cause changes in gut bacteria that allow Enterococcus bacteria to grow in the intestines. From there, Enterococcus bacteria move to the liver where the bacteria promote liver damage, inflammation, steatosis, and fibrosis by increasing the progression of these liver diseases: alcohol-related liver disease (ARLD), alcoholic steatohepatitis, non-alcoholic fatty liver disease (NAFLD), and nonalcoholic steatohepatitis (NASH).3

People who have an existing liver disease due to alcoholism or by obesity or through other means prove to be at greatest risk of liver damage when using PPIs. Though PPIs were the heartburn medication of focus in this study any medication that suppresses or neutralizes stomach acid can change intestinal bacteria and potentially cause liver damage in the same manner.

Overview of the Studies on PPIs and Liver Disease

Studies in Mice

To test whether PPIs cause liver damage, the researchers studied their effects on mice that were modified to emulate alcoholic liver disease in humans. Either gastric acid production was blocked by genetic engineering or through administering the PPI omeprazole.

Findings showed that mice with gastric acid suppression developed more Enterococcus faecalis bacteria than mice without gastric acid suppression.

To take the research in mice one step further and confirm their findings, Schnabl and his research team emulated the longer-lasting intestinal overgrowth of Enterococci through gastric acid suppression by inducing Enterococcus faecalis bacteria. They found that Enterococcus increased the progression of chronic liver disease in mice.

Studies in Humans

The findings from the study on mice were then confirmed in humans. A cohort study of humans who abuse alcohol was done by analyzing Enterococcus faecalis bacteria levels in stool samples. The study in humans included 4,830 patients who abused alcohol:

  • 1,024 patients were active PPI users
  • 745 patients previously used PPIs
  • 3061 patients had never used PPIs

Through the study of these patients, they proved the correlation between PPI use and liver damage in those who abuse alcohol. Also revealed was the 10-year risk of someone who abuses alcohol being diagnosed with alcoholic liver disease…

  • 20.7% for the individual currently taking PPIs
  • 16.1% for the individual who previously used PPIs
  • 12.4% for the individual who had never used PPIs

The risk of an alcoholic developing liver disease was revealed to be 8.3 percent higher for the individual using PPIs than someone who never used PPIs.

Discontinue PPIs or Continue Taking PPIs?

The instance of chronic liver disease is rising, liver cirrhosis is the 12th leading cause of death worldwide. Alcohol use makes up 47.9% of all cirrhosis-related deaths.4

PPIs are one most heavily prescribed class of drugs in the world and are the goto drug for treatment of GERD. GERD is experienced by a wapping 42% of people in Western cultures on a monthly basis.5 And a higher percentage of those who take PPIs due to GERD are people with chronic liver disease.6

If you are going to an alcohol rehab center, a PPI may be prescribed to you. Speak to your doctor about possible side effects especially the possibility of liver damage. Do not take PPIs without first speaking with your doctor. Do not take PPIs long-term without being under the close supervision of your doctor. This is especially important if you drink a lot of alcohol, are overweight, or at risk of developing liver disease.

Most of the time diet and lifestyle are both the culprit of acid reflux and ultimately the cure. Positive diet and lifestyle changes allow most people to discontinue PPIs and control GERD symptoms naturally.


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