KEY POINTS

  • Proton pump inhibitors (PPIs) help reduce the amount of stomach acid
  • Coronaviruses might survive in an environment neutralized by PPIs
  • People who take PPIs on a regular basis are therefore more susceptible to COVID-19

Here comes yet another addition to the long list of risk factors for COVID-19. A recent observational study of over 53,000 Americans pointed out that drugs commonly used to relieve symptoms of acid reflux or gastroesophageal reflux disease (GERD) increase a person’s odds of reporting a positive COVID-19 test.

Despite being warned of adverse effects like bone fractures and heart attacks, 15 million Americans still continue to take proton pump inhibitors (PPIs) on a regular basis.

The researchers reported that PPI use, especially when taken twice every day, was linked to increased odds for testing COVID-19 positive, despite accounting for several lifestyles, sociodemographic and clinical variables.

“Our findings continue to emphasize that PPIs should only be used when clinically indicated at the lowest effective dose,” Christopher V. Almario, MD, MSHPM, from the Department of Medicine at Cedars-Sinai Medical Center in Los Angeles, told Healio Gastroenterology.

The study:

Among the 53,130 Americans who were surveyed, 3,386 tested positive for the coronavirus infection. The researchers noted that people who took PPIs either once daily or twice daily had a significantly higher odds for reporting a COVID-19 positive test compared to those who didn’t use those drugs or those who used histamine-2 receptor antagonists (H2Ras).

How does heartburn medications increase the risk of COVID-19?

Although the impact of acid suppression on the novel coronavirus remains unclear, prior data revealed that gastric pH levels less than 3 impaired the infectivity of the virus.

Stomach acid is there for a reason: to kill pathogens before they enter the digestive tract.

The researchers believe that the coronaviruses can easily be destroyed at a gastric pH of less than 3, but survive in a more neutral pH, including the range created by PPIs like omeprazole and esomeprazole.

Does this mean people should stop taking PPIs?

No, the researchers say that people shouldn’t just stop taking their prescription medications. PPIs work and in most cases, the benefits even outweigh the risks.

They highlighted that the decision about whether, when, and how to modify the drug dosages should always be based on a thoughtful assessment of the risk-benefit ratio for each individual.

“As with any medication, the lowest effective dose should be used when clinically indicated, and, when appropriate and consistent with best-practice guidelines, H2RAs may also be considered as an alternative treatment for acid-related conditions,” Healio Gastroenterology quoted Brennan M.R. Spiegel, MD, MSHS, professor-in-residence of medicine and public health at Cedars-Sinai Medical Center, David Geffen School of Medicine at UCLA and UCLA Fielding School of Public Health.

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