
Acid reflux drug linked to more than doubled risk of stomach cancer - leoh
https://www.theguardian.com/science/2017/oct/31/acid-reflux-drug-linked-to-more-than-doubled-risk-of-stomach-cancer-study?CMP=fb_gu
======
ksk
>>Responding to the study, Stephen Evans, professor of pharmacoepidemiology at
the London School of Hygiene and Tropical Medicine, said: “Many observational
studies have found adverse effects associated with PPIs.

>>"The most plausible explanation for the totality of evidence on this is that
those who are given PPIs, and especially those who continue on them long-term,
tend to be sicker in a variety of ways than those for whom they are not
prescribed."

Why is this not at the beginning of the article?

I suppose, the silver lining is that the headlines are no longer "X causes
cancer", but "X linked to cancer".

------
jakebasile
Nothing gives you a morning dose of fear like reading this about a drug you’ve
been on for 6 years. Guess I’ll start looking into alternatives and ways to
screen for stomach cancer.

~~~
jasonhn9999
Paradoxically, I cured my reflux with betaine HCL (with pepsin) and digestive
enzymes.

I found that when I eat meat and/or when I’m stressed, my body doesn’t
naturally produce enough “good” acid. This leads to a build up of reflux
because the meat is essentially rotting in my stomach, which creates awful
“bad acid” reflux.

Instead of the drug(s), with every meal, I recommend taking one capsule of
betaine HCL (with pepsin) and one digestive enzyme capsule.

~~~
H1Supreme
> my body doesn’t naturally produce enough “good” acid

Exactly. The amount of people completely, and utterly, misinformed about acid
reflux is astounding. You don't have too much acid, you don't have enough!

Ditching the dairy and drastically cutting back on animal flesh will cure most
heartburn/acid reflux.

~~~
mlloyd
For me it was increasing meat and fat and cutting carbs. Doing that has all
but eliminated my reflux until I change my diet for a moderate amount of time.

~~~
CodeCube
For me, it's cutting out (or at least, reducing) Pizza... my favorite part of
the food pyramid

------
forgotmyacc
People don't realize PPIs are a short term solution. PPIs are terrible long
term. That being said, I'd be long dead without them. They are truly a life
saver until you find out the root cause. Many trips to the ER and years later,
I found out avoiding gluten and taking probiotics cured mine.

~~~
le-mark
Indeed, I was on PPIs for years. Before them, I used to wake up choking on
bile, I was eating tums like candy. Then I changed my diet and starting taking
baking soda in water of all things. When travelling I'll go back on PPIs for
the trip, and notice a distinct feeling of unwellness. But I simply don't want
to deal with questions of the form; 'what's this white powder in your
luggage?' so I deal with it.

~~~
jerf
I've had to make my peace with just having to hit a store on the other side of
the trip. Fortunately, baking soda is cheap enough that you don't have to mind
throwing it away.

You could also conceivably make your own pills, which at least in my
experience nobody will question: [https://www.amazon.com/Cap-M-Quik-Tamper-
Capsule-Filling-Mac...](https://www.amazon.com/Cap-M-Quik-Tamper-Capsule-
Filling-
Machine/dp/B000UYA272/ref=sr_1_1_a_it?ie=UTF8&qid=1509550476&sr=8-1&keywords=cap-
m-quick&dpID=41NMjuYYhvL&preST=_SX300_QL70_&dpSrc=srch) (I don't make my own
pills, but I've carried around a variety of pills that look like they were
made that way.) But for baking soda that's probably a little elaborate, plus I
don't know what happens if you take baking soda that way rather than in water.

------
oliwarner
Hacker News continues to amaze. There's always a worrying high ratio of
comments in health and diet threads from people making drastic and impulsive
decisions without medical advice, usually off the back of incomplete
conclusions or anecdote.

Newspaper coverage certainly needs to contain more scrutiny of the quality of
scientific papers (and their review), but this paper explicitly concludes that
there are other factors at work.

Don't stop taking your meds. If you have reflux issues and you're concerned
about this, take the paper to your specialist and get their informed opinion.

~~~
Bartweiss
Notably, this isn't the first study to raise an uncertain, correlation risk
about PPIs. A specialist, or in many cases even a GP, should be aware of the
topic and able to answer questions.

I'm also a bit disturbed to see people framing this as "comfort versus cancer"
\- seeing as untreated acid reflux can be a cause of esophageal cancer, "I'll
just quit without asking a doctor" is far from a sound course of action.

~~~
archagon
I wish there was more info out there on the risks for reflux -> Barret’s ->
cancer. I could barely find anything when I last looked, except that frequent
reflux sufferers are advised to get an endoscopy once every few years. (So I
guess Barret's develops pretty slowly?) Also, the fact that smoking is
correlated with both reflux and cancer significantly confounds the issue.

------
drdaeman
Why almost no journalist ever links to the actual research papers, or, at
least, properly name the authors and the paper title? Is it that hard to put a
DOI in a small font somewhere? (Or am I just blind?)

~~~
occam65
Yeah, I had to try to find it myself as well. I believe this is the one:

[http://gut.bmj.com/content/early/2017/09/18/gutjnl-2017-3146...](http://gut.bmj.com/content/early/2017/09/18/gutjnl-2017-314605)

~~~
s0rce
Thanks, I came to the HN comments to see if someone posted the link to the
study.

------
yawz
Damn! And if you don't treat your acid reflux, it can cause "esophageal
cancer".

~~~
Diederich
Maybe growing numbers of "damned if you do, damned if you don't" situations
are the natural result our current 'late stage' medicine.

An analogy that came to mind: an enormous, largely opaque codebase that works
very well. Most of its behaviours given most inputs are well understood, most
of the time, and endless optimizations have caused it to reach a pretty good
level of stability.

But maybe, going forward, more and more small optimizations and bug fixes
cause as many problems as they fix.

Clearly we need to re-factor ourselves. (:

------
dm319
It worries me when I read an article like this, then see people in the
comments suggesting that they're stopping their PPI prescription. Which
ironically might increase their chance of cancer, depending on the indication.

Even at the end of the article the authors conclude:

> “The most plausible explanation for the totality of evidence on this is that
> those who are given PPIs, and especially those who continue on them long-
> term, tend to be sicker in a variety of ways than those for whom they are
> not prescribed.”

That's because this is an _observational_ study. That means there is probably
another confounding factor that is perpetuating the use of a PPI in some
people, but not in others. Sometimes these confounding factors are
controllable - as long as you know what they are - but usually they are not.
For example, those who were taking omprezole may have peptic ulcer disease -
which would put you at risk of gastric cancer, and for which the PPI is used
to reduce the acidity of the stomach, and reduce the risk of ulcers and
inflammation (which can be a precursor or risk factor for cancer). Similar
story for gastro oesophageal reflux disease, where the risk is to the
oesophagus.

If you want to answer the question 'Does taking a PPI increase my risk of
gastric cancer?' you need another type of study. That is a randomised
controlled trial, where you randomise people to either the PPI tablet, or a
placebo, then measure what happens. This allows you to infer causality, and
the randomisation prevents confounding factors.

Thankfully this has been done[1]. It's only one paper from a low-impact
journal, but none-the-less a meta-analysis of several RCTs setting out to
answer a specific question holds more weight than an observational study.

Also, I'm not a gastroenterologist, so if there is one out there who
understands the field better, please chime in. Specifically, if you have a
clear medical reason to be taking a PPI (i.e. reflux with oesophageal
histology changes), are there RCTs comparing PPI use versus not? I've done a
quick google and this [2] study seems relevant - they suggest that if you have
mild disease you can just take the PPI when you have symptoms, but not for
severe disease. However, they didn't assess cancer risk.

[1]
[https://www.ncbi.nlm.nih.gov/pubmed/23906249](https://www.ncbi.nlm.nih.gov/pubmed/23906249)

[2]
[http://onlinelibrary.wiley.com/doi/10.1111/j.1365-2036.2007....](http://onlinelibrary.wiley.com/doi/10.1111/j.1365-2036.2007.03381.x/full)

------
d--b
Not to mention cognitive impairment:
[https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4696341/](https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4696341/)

~~~
ghostbrainalpha
Jesus.... why isn't that being talked about more.

I got off acid reflux drugs because of the cancer risk by taking a probiotic,
which took about a month to have the same effect.

Next week, we will find out the probiotics cause cancer and mental impairment.

~~~
d--b
and aspirin is apparently good to prevent those. Yet, it'll tear a hole in
your stomach... sigh...

[http://www.telegraph.co.uk/science/2017/10/30/aspirin-day-
ke...](http://www.telegraph.co.uk/science/2017/10/30/aspirin-day-keeps-many-
cancers-away-study-suggests/)

------
trhway
>Daily use of PPIs was associated with a risk of developing the illness that
was more than four times higher (4.55) than those who used it weekly.

(IANAD) from what i read on the pill boxes, PPI are supposed to be used max 2
weeks in 4 month period. If you look at the micrograph photo at
[https://en.wikipedia.org/wiki/Proton-
pump_inhibitor](https://en.wikipedia.org/wiki/Proton-pump_inhibitor) showing
cell hyperplasia (possible precursor to cancer) resulting from PPI use you'd
get the idea. (note: myself use PPI 2 weeks in 4 months (and they do have
noticeable lasting effect for long after the 2 weeks course due to nature of
their action), and the rest of the time H2 blockers. I limit the PPI exactly
because scared by that hyperplasia photo (and now that i read the other
comment about cognitive impairment i'm scared even more :). Again - all that
is "self-prescribed"/"internet researched", IANAD.

------
hprotagonist
Just to cast the exact same finding in a different way, this appears to raise
the incidence rate of stomach cancer from 0.8% to 1.6%.

~~~
vixen99
So where do these numbers come from? Who was in the study and where was it
done?

~~~
hprotagonist
my numbers are overall cofirmed incidence rates. CDC has them.

------
yeureka
As someone who as been taking these for 3+ years and is utterly scared of
these news I would just like to add a few data points regarding my experience
that might help others:

\- an endoscopy revealed level 1 oseophagitis

\- triggers for me include: coffee, tea or any other source of caffeine, fried
and high fat foods, alcohol, acidic fruits, high protein foods.

\- an experiment with betaine HCL + pepsin was very painful. After that I
learned that pepsin is as bad or worse to your oesophagus than stomach acid.

\- cider vinegar: same result as betaine HCL + pepsin.

\- digestive enzymes: no change.

\- pro-biotics, including kefir: no change.

\- cutting gluten, dairy and sugar: no change.

\- ranitidine: works but effectiveness drops rapidly.

\- on-going experiments: liquorice and low-fodmap diet, no conclusions yet.

~~~
nwienert
went through almost all of your points actually. though my symptoms were
"gastro-attacks" of frightening intensity where i'd end up in hospital. ended
up having gallbladder removed after test showed it very-low functioning and
had complete recovery. took PPI's still intermittently, but tapered off after
a couple years.

------
rconti
50 million prescriptions "per year" in the UK? There are only 65 million
people in the UK. How do they count this? Is every PersonMonth counted as a
prescription? What if you get your refills quarterly instead of monthly?

------
olegkikin
PPIs are also linked to 50% higher death rate:

[https://medicine.wustl.edu/news/popular-heartburn-drugs-
link...](https://medicine.wustl.edu/news/popular-heartburn-drugs-linked-
higher-death-risk/)

------
gabrielbrangers
Ironic. A friend of mine was prescribed PPI to help prevent esophageal cancer.

~~~
debacle
Constant reflux does tend to cause esophageal cancer as well as other issues
related to breathing and swallowing.

------
debacle
I mostly suppress my reflux through a twice daily regimen of cider vinegar
(diluted* ), more walking, eating more conscientiously, and forcing myself to
sleep on my left side.

These are all very minor changes, and the biggest impact came from sleeping on
my side.

My gastroenterologist was very against the daily PPI my primary put me on.
There are a lot of potential negatives there.

* Straight up cider vinegar is very acidic and can irritate or damage the throat and mouth. I drink 1/2 tbsp in a glass of water.

~~~
mschip
I was on PPIs for reflux for about 6 years before realizing how damaging they
could be. Getting off them was really difficult but your suggestions here, in
addition to some ginger supplements, helped me to ween off them. Getting off
them was a terrible experience, but I'm much better off because of it. I
rarely experience reflux anymore.

~~~
chojeen
For a couple of years, the only thing that worked for me was mega-huge doses
of PPI's. After several pH studies, endoscopies, and other tests confirmed
that I don't have abnormal reflux, food allergies, gluten sensitivity, or
anything else, my doctor(s) and I found after years of trial-and-error that a
combination of H2 blockers and a low-dose of antidepressants mostly controls
my symptoms, which are probably caused by an overly-sensitive gastric nervous
system.

------
propman
In the article it says up to 8 fold increase in stomach cancer for 3+ years,
that is insanely significant and for those taking it for 1+ years it's 4-fold.

I was prescribed this for long term use because mine is especially bad but I
was too lazy to follow through and felt embarrassed asking for it again so I
just eliminated some trigger foods and followed doctors advice on posture and
letting food digests for an hour before lying down. It made a huge difference

------
Blueliner
After having every member of my family get cancer except me I have extensively
studied and found proven ways to prevent cancer based on long term studies. I
also serve as a patient advocate helping people battle their cancers. In
addition I have had gastrointestinal and digestive issues in the past and
after lots of doctors, tests, treatments, etc. here are the things that I have
found to have worked:

Cancer Prevention (All Types Including Gastric/Stomach Cancer): 1) Don't smoke
2) Eat a plant based (vegan) diet consisting of mostly fresh raw vegetables
(raw foods contain natural digestive enzymes which help digest food better as
well as being packed with cancer fighting nutrients) 3) Eliminate processed,
fried, additive-laden foods 4) Avoid exposure to chemicals, toxins and other
environmental contaminants that are known carcinogens. 5) Get plenty of sleep
every night to strengthen the immune system. 6) Get a minimum of 150 minutes
of cardiovascular exercise each week (more is even more effective) 7) Minimize
daily stress to the greatest extent possible (stress wreaks havoc on the body
and seriously damages immune function). 8) Drink plenty of water every day.

To Improve Digestive Health/Minimize Acid Reflux & Other GI Health Problems:
1) Eat more raw vegetables which have naturally occurring digestive enzymes
(cooking destroys most of these). 2) Eat slowly and chew your food thoroughly.
Digestion starts in the mouth with saliva. 3) Don't drink water or other
fluids during and for at least 3-4 hours after meals which will dilute stomach
acid & negatively impact digestion and break down of food. 4) Eat raw
fermented foods with naturally occurring prebiotics & probiotics such as
kombucha tea, raw apple cider vinegar (1 tablespoon on food at each meal 3X
per day), etc. Studies have shown that pre/probiotic supplements are not
effective, only natural foods work. 5) Try and eat smaller, more frequent
meals. Large meals are harder to digest & make it hard for the stomach to
fully clear food that is eaten which can increase acid reflux/GERD. 6) Avoid
bad oils and fats and stick to good fats virgin coconut oil, olive oil, nuts,
seeds, avocados, etc. [http://drcate.com/list-of-good-fats-and-oils-versus-
bad/](http://drcate.com/list-of-good-fats-and-oils-versus-bad/) 7) Eat more
high fiber foods.

These are some suggestions based on many years of research and what I have
found to work the best. I'm happy to answer any questions.

------
hi41
I have been using on Prilosec and Nexium since 2000. If I miss taking the
medication I get severe stomach pains by late evening. In the last endoscopy
the doctor noticed several polyps in my stomach. He said polyps are normal for
someone who has been using Prilosec and Nexium for so long. Is stomach polyps
a precursor to cancer?

------
Angostura
> “The most plausible explanation for the totality of evidence on this is that
> those who are given PPIs, and especially those who continue on them long-
> term, tend to be sicker in a variety of ways than those for whom they are
> not prescribed.”

~~~
e40
After being on Prilosec for 2 years, I had an endoscopy and the pictures of
the inside of my stomach were odd. Little bumps over the entire inside. I
asked the doc and he said "we don't think those are a problem". Right. I got
off it immediately.

~~~
Bartweiss
He had a point, though: PPIs are known with very high certainty to cause
benign polyps from the fundic glands. Even if they do cause cancer, it's not
by that means.

Whether or not they're a good drug to be taking long-term, I think the
doctor's response was sound.

------
trey-jones
The same PPIs were linked to dementia in a study a few years ago, and I began
to transition off at that time. I eat a lot of Tums and generally just try to
be more mindful of what I eat. I'm also considering surgery at some point.

~~~
jcadam
I switched from protonix (a PPI) after 6 years of constant use to Pepcid (an
H2 blocker). Rebound reflux is real and I had to wean myself off the PPI
gradually. Now, I take 40mg of Pepcid daily and Tums as needed.

Usually I'm allright if I avoid trigger foods (anything high in saturated fat,
excessive sugar, onions, etc.). For some reason I can handle drinking coffee
but black tea triggers my reflux like nothing else.

------
gumby
> "In the UK, there are more than 50m prescriptions for PPIs every year..."

I can't believe this. There are only 65MM poeople in the UK, so 50 million
would exceed the adult population.

~~~
MattLeBlanc001
Maybe repeat prescription for the same patient are counted.

------
wisecoder
Check for gluten intolerance or just follow gluten free diet without any omez
tablets for a month. You will never ever get Acid reflux.

I am free of Omez and Acid reflux for the past 6 months.

------
acidreflux
I am absolutely not surprised that people who are more at risk of stomach
cancer... get stomach cancer. Notice how the study found no causal link.
Indeed, the last paragraph in the article confirms that it’s probably because
the people who are prescribed PPIs are already sick. (Side note: I’m one of
those people who’s probably on them for life unless I want to die horribly of
esophageal cancer like my father did.)

