Risk of death among users of Proton Pump Inhibitors: a longitudinal observational cohort study of United States veterans
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    Re: Risk of death among users of Proton Pump Inhibitors: a longitudinal observational cohort study of United States veterans
    • Titilope. O. Olanipekun, Resident Physician Department of Internal Medicine, Morehouse School of Medicine, Atlanta Georgia
    • Other Contributors:
      • Abimbola Chris-Olaiya, Resident Physician

    We read with great interest the longitudinal study by Xie et al on the Risk of death among users of Proton Pump Inhibitors (PPI) (1). The study findings suggest that there is an overall increased risk of death among PPI users when compared with histamine H2 receptor antagonists (H2 blockers) users and people who are not on either medication. We also acknowledge the efforts of the authors to statistically eliminate potential bias associated with an observational study design like this. However, we would like to highlight a few points which we believe should be considered when interpreting the results of the study.

    The authors externally adjusted for the use of other therapeutics including anticoagulants, antiplatelet agents, and non-steroidal anti-inflammatory drugs as potential confounders. However, it is not clear if Selective Serotonin Receptor Inhibitors (SSRIs) used in the treatment of Post-Traumatic Stress Disorder (PTSD) were considered and adjusted for. The Veteran population which forms the data set for this study has a higher prevalence of PTSD than the general population and is often prescribed SSRIs (2). The SSRIs are metabolized by the cytochrome P-450 isoenzyme CYP2C19, which is inhibited by the proton pump inhibitors (PPIs) leading to significantly higher levels of SSRIs in the body and potential risk of increased adverse effects (3). Some of the adverse effects of SSRIs including suicide risk could significantly contribute to mortality in the popu...

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    Conflict of Interest:
    None declared.