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Proton Pump Inhibitors Increase Mortality Risk in COVID-19 Patients, Study Shows

A study shows that users of proton pump inhibitor or PPI who tested negative for COVID-19 reveals higher salivary angiotensin-converting enzyme 2 or ACE2 expression. Moreover, proton pump inhibitor use appears to increase risk of mortality in COVID-19 patients, specifically African American patients.

Proton Pump Inhibitors Increase Mortality Risk in COVID-19 Patients, Study Shows
Photo: Proton Pump Inhibitors | InStyleHealth

What Are Proton Pump Inhibitors?

Proton pump inhibitors (PPIs) are medication drugs or medicines that work by reducing the amount of stomach acid made by glands in the lining of your stomach.

What Are the Uses of Proton Pump Inhibitors?

  • Proton Pump Inhibitors or PPI relieve symptoms of acid reflux, or gastroesophageal reflux disease (GERD). This is a health condition in which food or liquid moves up from the stomach to the esophagus (the tube from the mouth to the stomach).
  • PPIs treat a duodenal or stomach (gastric) ulcer.
  • PPIs treat damage to the lower esophagus caused by acid reflux.

What Are the Types of Proton Pump Inhibitors or PPIs?

Proton Pump Inhibitors come in several names and brands. Most of these PPIs work equally as well. The side effects of PPIs may vary. The following are the known types of PPIs:

  • Dexlansoprazole (Dexilant)
  • Esomeprazole (Nexium), also available over-the-counter (without a prescription)
  • Lansoprazole (Prevacid), also available over-the-counter (without a prescription)
  • Omeprazole (Prilosec), also available over-the-counter (without a prescription)
  • Pantoprazole (Protonix)
  • Rabeprazole (AcipHex)
  • Zegerid (omeprazole with sodium bicarbonate), also available over-the-counter (without a prescription)

According to researchers PPI use was recently reported to be associated with increased SARS-CoV-2 infection and worse clinical outcomes. The underlying mechanisms for this association are unclear.

Prospective study of hospitalized COVID-19 patients and COVID-19 negative controls was carried out to understand how PPI use could affect ACE2 expression and stool SARS-CoV-2 RNA. The retrospective cohort analysis was also conducted on hospitalized COVID-19 patients from 15th March to 15th August 2020 to evaluate the correlation between PPI use and mortality. Predictors of in-hospital mortality were identified by including covariates with clinical relevance of COVID-19 results.

COVID-negative PPI users had higher salivary ACE2 mRNA levels than those non-users. Furthermore, salivary ACE2 levels and stool SARS-CoV-2 RNA detection rates were similar between PPI users and non-users.

Mortality rate was significantly higher among PPI users than the non-users (30% vs 12.1%), in 694 hospitalized COVID-19 patients with average age of 58 years old, where 46% were men, and 65% were African Americans. Mortality was predicted by the following factors: PPI use, age, race, cancer, and diabetes. Particularly, the risk of PPI-related mortality was higher in African American patients than others.


Source: Am J Gastroenterol 2021;116:1638-1645

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