An NHS doctor has urged people taking proton pump inhibitor (PPI) medication such as Omeprazole and Lansoprazole to come off it if they can, due to potential 'long-term risks'. Dr Alex Wibberley, a GMC-registered emergency medicine doctor, spoke on his YouTube channel about PPIs, which are taken by millions of people in the UK. Exact numbers are not known, but it is thought that one in seven people take PPIs throughout the UK. They are medicines that reduce the amount of acid in your stomach and are used to treat things like acid reflux, heartburn, and stomach ulcers.
Health concerns linked to long-term use
Although these medicines are generally safe, Dr Alex pointed to a range of health concerns - including gut infections, nutrient deficiencies, bone fractures, chronic kidney disease, and potentially some cancers - that have been linked to long-term use of PPIs. And while he stressed that the studies that found these observed a link rather than a cause, they represent enough of a risk that people who have been on PPIs for a long time should seriously consider coming off them if they can.
He said: "A lot of people ask about the long-term risks of these medications. And this is obviously where it gets quite important, and I want to be really straight with you about what the science actually says and what it doesn't."
"So, observational studies—meaning studies that watch large groups of people over time—they link long-term PPI use to a range of concerns, including gut infections, nutrient deficiencies in magnesium and vitamin B12, bone fractures as well, chronic kidney disease, and potentially some cancers, potentially."
"Now, that is a pretty significant list, but the crucial word here is observational. These studies show a link, not a proven cause. People on long-term PPIs tend on average to be older and sicker and on more medications, which makes it genuinely hard to untangle the drug's effects from everything else going on."
"So, the risks are real enough to take seriously, but they're not a reason to panic straight away. Basically, what all of this means is that we know that there is possibly some long-term risks of taking these long-term. So, surely if you can come off these medications, then that has to be safer for you."
What does the evidence say?
Dr Alex explained: "The nutrient story is probably the most clinically solid part of all of this. So, because stomach acid is needed to release vitamin B12 from food so the body can absorb it, PPIs reduce that process. And magnesium absorption is also affected as well, with several reports linking long-term use to low magnesium levels in the blood. Now, studies have shown a 12 to 18% reduction in vitamin B12 levels over 12 months of PPI use. And calcium absorption is also reduced, which matters enormously for your bone strength over time."
"Low magnesium might not sound dramatic, but magnesium is involved in over 300 processes in the body, including muscle function, nerve function, your heart rhythm, your blood sugar control. And severe magnesium deficiency actually from long-term PPI use has caused documented cases of serious heart rhythm disturbances and muscle spasms as well. If you are on long-term PPIs and nobody has ever checked your magnesium or your B12 levels, then you need to have that conversation with your doctor."
On cancer specifically, what the evidence seems to show—and again, it's not been proven, but what it seems to show—is that prolonged PPI use exceeding 3 months is associated with an elevated risk of certain cancers, including gastric, oesophageal, and colorectal cancer, though the precise mechanism is still being worked out. Like I said, this isn't factual yet. One proposed reason is that by suppressing acid so powerfully, PPIs change the environment in your gut, altering the bacteria living there and potentially allowing cell damage to go on longer than it otherwise would.
"Now, a large study from Hong Kong found that long-term PPI use after treating an H. pylori infection was associated with a higher risk of gastric cancer, although underlying damage to the stomach because of the infection might explain part of that finding. Again, it's association, not proof, but it's worth knowing about if you've been taking these tablets for years without anybody ever reviewing whether you still need them or not."
What about the NHS?
The NHS says that PPIs are safe in the long-term - when prescribed by a doctor who has weighed the benefits against the potential risks. PPIs are usually prescribed for four to eight weeks for indigestion symptoms. They should be taken for as short a time as possible to avoid long-term side effects. However, in some instances long-term PPIs are necessary but the dose may change to a lower maintenance dose. Your GP practice will advise depending on what you need.
Your dose of PPI may be changed by your GP practice to ensure that you are on the lowest dose possible for the least amount of time. When you 'step down' or stop your PPI we know that indigestion symptoms can return temporarily, sometimes worse than before. These symptoms usually settle after two to four weeks of stopping the PPI and can be managed with an antacid or alginate. After you finish your PPI course, it is important to reduce the risk of your indigestion returning through self-help looking at lifestyle factors on the next page.
