Rikke B Nielsen;
Asbjørn Mohr Drewes;
Finn B Larsen; CFK - Folkesundhed og Kvalitetsudvikling
Reimar W Thomsen;
After the introduction of proton pump inhibitors (PPIs) more than two decades ago, many studies have documented their beneficial effect in inhibiting gastric acid production.1–5 PPIs are now the drugs of choice for treating gastroesophageal reflux disease (GERD), which occurs in 42% of Westerners on a monthly basis, as well as for treating peptic ulcer disease, Helicobacter pylori infection, and Zollinger–Ellison syndrome.6–9 Their treatment effects have been well described, and PPIs are now among the most prescribed drugs in the world.10–16
As PPIs are considered generally safe drugs to use, a large percentage of patients is prescribed PPIs without a proper medical indication.17,18 However, some observational database studies have suggested an increased risk of adverse events associated with PPI use, including cancer, osteoporosis, fractures, diarrhea, cardiovascular events, and pneumonia.19–25 Most studies have not been able to adjust for potential differences in health status and lifestyle distinguishing PPI users from nonusers, which may lead to biased associations. Thus, many studies have found an association between unhealthy traits, such as increased body mass index (BMI) scores,26–34 alcohol consumption,28,34,35 and smoking,33,34,36,37 and the risk of GERD, which is an important medical indication for PPI therapy. However, PPI use might be associated with increased health consciousness (frequent consultations with physicians, healthier lifestyle, etc) as is the case for the use of some other prophylactic drugs (eg, statins).
To the best of our knowledge, no study has provided data on health status and lifestyle among PPI users and nonusers in the general population. Such data are needed to evaluate uncontrolled confounding from lifestyle factors in observational PPI studies. Using data from a population-based health survey of 21,637 persons, linked to a nationwide Danish prescription database, we examined BMI, smoking habits, alcohol consumption, physical exercise habits, comorbidity, and diet in relation to PPI use.