Acid Reflux Medications can Lead to Liver Inflammation and Damage

Your liver plays an important role in food digestion, and processing and distribution of nutrients. You need a healthy liver for survival. Although your liver has the potential to regenerate itself post a damage, recurrent or long-lasting injury can lead to the formation of scar tissue. This scarring of the liver can cause cirrhosis, a condition which disrupts the normal functioning of the liver. Liver cirrhosis is one of the important causes of death worldwide.

Cirrhosis can be caused by different conditions including obesity, which leads to NAFLD (non-alcoholic fatty liver disease) and NASH (non-alcoholic steatohepatitis), one type of NAFLD where there is also liver inflammation and damage. Of all the causative factors of cirrhosis-related deaths, alcohol misuse is a leading factor, contributing to about half of the associated fatalities.

Modifications in your gut’s microbiota or microorganisms can contribute to liver disease. Alcohol abuse and use of PPIs or proton pump inhibitors (a class of heartburn medication) can modify your gut’s microbiota. PPIs block stomach acid secretion, and are usually taken by individuals with chronic liver disease. However, the effect of these drugs on the progression of liver disease has not been previously studied. The current research was directed in this line.

The Current Research
A team of scientists headed by Dr. Bernd Schnabl at the University of California San Diego School of Medicine, set out to find whether blocking stomach acid has an impact on chronic liver disease. Their initiative was partly funded by NIH’s National Institute on Alcohol Abuse and Alcoholism (NIAAA). They investigated the role played by PPIs in mouse models with three types of liver disease viz., NASH, NAFLD, and alcohol-induced liver disease. They also analyzed PPIs in humans. The findings of the study were published in Nature Communications on October 16, 2017.

The researchers blocked stomach acid in the mice either by administering Prilosec (PPI omeprazole) or genetically removing the gene responsible for stomach acid secretion. They found that when stomach acid was lacking, the liver conditions of the mice worsened in all the three disease models.

The scientists found that lack of stomach acid in mice led to higher levels of intestinal bacteria and microbial imbalances. Specifically, the levels of Enterococcus in the mice’s guts had increased. They conducted further experiments which demonstrated that these bacteria got to the liver and caused inflammation and damage there.

To know whether similar kind of microbiota alterations occur in human beings too, the researchers tested the fecal samples of healthy individuals before and after PPI treatment. They found that there was higher a higher number of Enterococcus after two weeks of PPI treatment.

The scientists then wanted to analyze a possible association between PPIs and the development of alcoholic liver disease. They investigated 4,830 patients diagnosed with alcohol use disorder. 36% of them were using PPIs. They found that usage of PPI increased one’s 10-year risk of developing liver disease (12.4% for individuals who never had used PPIs; 16.1% for those who had used PPIs previously; and 20.7% for active users of PPIs).

Conclusion

The authors relate their research findings with the current worldwide scenario where there is an increased incidence of chronic liver disease. They believe that the recent increase in the use of acid reflux medications might have resulted in this. So, they suggest that clinicians should consider restraining the prescription of stomach acid suppressing drugs unless there is a strong medical condition.

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