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The number of seniors taking acid-reducing drugs to treat gastrointestinal woes has soared by 60 per cent over the past five years, newly released data show.

More than one in five Canadians over the age of 65 were treated with proton pump inhibitors (PPIs) in 2007-08, up from one in eight in 2001-02, according to the Canadian Institute for Health Information.

"Usage seems to be steadily increasing," said Michael Gaucher, manager of pharmaceuticals at CIHI.

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Part of the increase seems to be a switch from an earlier class of medication known as histamine-2 receptor antagonists (H2RAs), but there also seems to be an increase in acid-related conditions, he said.

PPIs and H2RAs are used to treat gastroesophageal reflux disease (GERD), reflux esophagitis and peptic ulcer disease. They are also used to eradicate Helicobacter pylori, a bacterium that causes ulcers, and to prevent and treat ulcers caused by routine use of medications such as painkillers.

There are many brand-name and generic PPIs.

The big sellers include pantoprazole (brand name Pantoloc), esomeprazole (Nexium) and lansoprazole (Prevacid).

Laura Targownik, an assistant professor of medicine at the University of Manitoba in Winnipeg, said the use of PPIs - which work by decreasing the amount of acid the stomach produces - has increased because they are effective and generally safe.

"We don't have a lot of other medications for these conditions," she said.

In recent years, there have been a number of safety concerns raised in relation to PPIs. Their use, and long-term use in particular, has been associated with a higher risk of hip fractures, heart attacks and infections such as Clostridium difficile and pneumonia.

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Dr. Targownik, who specializes in gastroenterology, said those risks must be kept in perspective and balanced against the benefits of the drug.

What is essential for patients and physicians alike, she said, is to ensure that use is appropriate, particularly long-term use.

Sometimes heartburn can be treated with over-the-counter acid neutralizers such as Tums, or with H2RAs such as Zantac. But in many instances, more powerful PPIs are the best choice.

"If there is a valid indication, then continue using PPIs. So I advise their use - with caution," Dr. Targownik said.

Last year in Canada, there were 17.4 million prescriptions for proton pump inhibitors and sales totalled $1.3-billion, according to IMS Health Canada, a private company that tracks prescription drug sales.

About half those prescriptions were used by seniors.

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CIHI's study was based on public drug insurance claims for Canadians aged 65 and older in six provinces - Alberta, Saskatchewan, Manitoba, New Brunswick, Nova Scotia and Prince Edward Island.

Over the study period, total drug program expenditures on PPIs across the six provinces increased at an average annual rate of 8.9 per cent - resulting in a doubling of costs to the public treasury over a five-year period. PPIs accounted for 7.3 per cent of total drug program expenditures last year.

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About the Author
Public health reporter

André Picard is a health reporter and columnist at The Globe and Mail, where he has been a staff writer since 1987. He is also the author of three bestselling books.André has received much acclaim for his writing. More

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