Heartburn medications are among the most widely prescribed drugs worldwide as treatments for gastroesophageal reflux disease (GERD). But while most GERD meds are safe to use, several small studies have raised concerns that long-term use of certain drugs known as proton pump inhibitors (PPIs) may increase the risk for developing certain health conditions, including stomach cancer.
The good news is that most large studies have found the use of PPIs — particularly when used briefly at low doses — poses no risk and many safe alternatives are available, such as H2 (histamine-2) blockers.
“Overall, PPIs and H2 blockers are incredibly safe medicines that are very effective in treating GERD,” says Jae Y. Kim, M.D., chief of thoracic surgery at City of Hope® Cancer Center Duarte. “Most PPIs have U.S. Food and Drug Administration-labeled durations of up to four weeks for the treatment of symptomatic GERD, and we generally recommend using the lowest effective dose for the shortest duration appropriate to the condition being treated.”
But if you have chronic GERD, which may increase the risk for developing upper gastrointestinal cancers (such as stomach cancer and esophageal cancer), it’s important to weigh the risks and benefits of prescription and over-the-counter heartburn medicines. Lifestyle changes — such as losing weight and avoiding late-night meals — may also combat GERD and should be the first line of treatment, Dr. Kim says.
This article explores the basics on heartburn drugs, GERD and cancer, including:
- Proton pump inhibitors may be linked to stomach cancer
- Tagamet, Pepcid: Alternatives to PPIs
- Zantac: Mixed findings on cancer risks
- GERD and cancer
- GI symptoms: When to see a doctor
If you or a loved one is concerned about possible signs or symptoms of cancer and would like an initial appointment or a second opinion, call us 24/7 at 877-460-4673.
Proton Pump Inhibitors May Be Linked to Stomach Cancer
Stomach cancer (also known as gastric cancer) is one of the leading cancers worldwide — the fifth-most commonly diagnosed cancer in the world and the third-leading cause of cancer death. Helicobacter pylori infection, which triggers gastric inflammation and may cause ulcers, accounts for most gastric cancer cases. But some studies have also linked PPIs to certain conditions, including upper GI cancers (such as stomach and esophageal cancers), when used over long periods of time, though researchers have reached conflicting conclusions about the significance of any potential risks.
PPIs are among the most widely used medicines, available over-the-counter (OTC) or via prescription, to reduce stomach acid. They include:
- Omeprazole (Prilosec®)
- Esomeprazole (Nexium®)
- lansoprazole (Prevacid®)
- Pantoprazole (Protonix®)
- Rabeprazole (AcipHex®)
- Dexlansoprazole (Dexilant®)
PPIs work by suppressing gastric-acid production, which may result in abnormally high levels of the hormone gastrin (a condition known as hypergastrinemia), bacterial overgrowth in the gut.
“PPIs and to a lesser extent, H2 blockers, work by shutting down the stomach’s acid secretion,” Dr. Kim says. “This can have some adverse effects such as increasing the risk of problematic bacteria in the intestines, including C. difficile infection. The decreased acid also impairs the absorption of certain minerals and vitamins, such as magnesium and calcium, possibly increasing the risk of osteoporosis.
“It is likely that the underlying conditions that cause people to use PPIs — ulcer disease or GERD — are associated with increased cancer risk, but it is unclear whether PPI use itself increases cancer risk. The evidence is conflicting, with the largest and best studies showing no increased risk.”
That’s why it’s important for people with GERD, a history of H. pylori infection or who have a higher risk for upper GI cancer to weigh the pluses and minuses of long-term PPI use, Dr. Kim says. It’s also critical to take into account other medications they’re taking — such as aspirin, statins and metformin — that may interact with PPIs.
Tagamet, Pepcid: Alternatives to PPIs
The good news is that PPIs aren’t the only treatment for GERD. Another class of drugs, called H2 (histamine-2) blockers, may be safer to use than PPIs, with studies finding no links to cancer, even when they’re taken for longer periods of time. These drugs work by blocking histamine-2 receptors in the stomach, halting the signals that produce acid.
Common H2 blockers include the popular medicines Pepcid® (famotidine) and Tagamet® (cimetidine), which provide long-lasting relief for many people who take them.
Also worth noting: For short-term heartburn relief, chewable OTC antacids like Tums® and Rolaids® (which are neither PPIs nor H2 blockers) work immediately to neutralize existing stomach acid. Both antacids contain calcium carbonate; Rolaids also contain magnesium hydroxide.
Zantac: Mixed Findings on Cancer Risks
Zantac® (ranitidine) is another H2 blocker used to treat heartburn and GERD, but an earlier version of the drug was recalled due to cancer-causing impurities found in the original formulation. In 2020, the U.S. Food and Drug Administration (FDA) issued an immediate market withdrawal request for Zantac after an investigation uncovered concerning levels of a potential cancer-causing substance known as N-Nitrosodimethylamine (NDMA) in ranitidine medications.
The original Zantac was then recalled by manufacturers and replaced with a new version, currently sold as Zantac 360°, which uses a different, safer active ingredient, famotidine.
The upshot: Do not take old Zantac.
GERD and Cancer
Heartburn may be merely a minor annoyance for most sufferers, but chronic GERD increases the risk for developing upper GI and gastric cancer, esophageal cancer and a condition known as Barrett’s esophagus, which may lead to cancer.
Taking GERD medication may combat the problem, but it’s not the only way to do so. Lifestyle changes and minimally invasive procedures are also effective, says Dr. Kim, adding that gastrointestinal cancer specialists take a “patient-centric approach” that accounts for an individual’s particular circumstances, preferences and goals.
“Lifestyle changes should be the first line of treatment for GERD,” he notes. “This includes weight loss if patients are overweight, avoiding alcohol and tobacco, avoiding late-evening meals and decreasing caffeine consumption.”
Dr. Kim also recommends avoiding carbonated beverages and not overeating. Following a Mediterranean diet with alkaline water has also been shown to improve GERD symptoms, he says.
“If lifestyle changes are insufficient, a stepwise approach should be used — first trying H2 blockers and using PPIs if H2 blockers are ineffective,” Dr. Kim adds. “Again, the lowest effective dose for the shortest duration of time should be used.”
In the event a patient needs to take PPIs for more than four weeks, he recommends evaluation by a gastroenterologist because the condition may indicate a more serious problem, such as a hiatal hernia. This occurs when the upper part of the stomach pushes up through a weakened opening in the diaphragm muscle, causing heartburn and GERD from stomach acid entering the esophagus.
“For patients with significant symptoms who don’t want to take medications long term, or if the medications don’t completely control symptoms, there are procedures that correct the underlying problem causing GERD, which for most patients, is the presence of a hiatal hernia,” Dr. Kim says. “These include minimally invasive procedures like transoral incisionless fundoplication and robotic hiatal hernia repair.”
GI Symptoms: When to See a Doctor
Anyone with long-term reflux or other unusual upper GI symptoms should make an appointment with a doctor or, more specifically, a GI specialist. This is especially important for people who experience any of these risk factors:
- Five years or more of reflux symptoms
- GERD symptoms from a young age
- Obesity
- History of smoking
If you or a loved one is concerned about possible signs or symptoms of cancer and would like an initial appointment or a second opinion, call us 24/7 at 877-460-4673.