Can common heartburn medicine increase my risk for COVID19?

Proton pump inhibitors or “PPIs” (such as omeprazole/Prilosec and esomeprazole/Nexium), a common class of acid reducing medications available by prescription and over the counter, work by turning off the pumps in cells that release acid into the stomach. They are commonly used as treatment for gastroesophageal reflux disease (GERD), gastritis or ulcers, and can be taken once or twice a day.  Although the impact of acid suppression on SARS-CoV-2 is unknown thus far, prior data has revealed that SARS-CoV-1 infectivity is impaired in a more acidic environment (pH <=3), the normal pH of a healthy stomach, whereas less acidic pH in the range achieved with PPI therapy does not inactivate the virus.  In a July study published in pre-print form in the American Journal of Gastroenterology, Dr. Brennan Spiegel at UCLA and his team of scientists conducted an online survey of over 50,000 people with a history of reflux symptoms, in which 3,386 (6.4%) reported a positive COVID-19 test.  In a regression analysis, which helps scientists to control for a wide range of confounding factors, the scientists found that individuals using PPIs up to once daily had a 2x likelihood for reporting a positive COVID-19 test when compared  to those not taking PPIs, and those taking PPIs twice daily had a 4x likelihood of reporting a positive COVID-19 test.  This was not true for other acid-reducing medications like H-2-receptor blockers (Pepcid/famotidine).  “This study does not mean that people on PPIs should just stop their medicines,” says Dr. Spiegel. “PPIs work and, in most cases, their benefits outweigh the risks. As always, the decision about whether, when, and how to modify PPI dosing should be based on a thoughtful assessment of the risk-benefit ratio for individual patients. As with any medication, the lowest effective dose should be used when clinically indicated, and, when appropriate and consistent with best-practice guidelines, H2RAs may also be considered as an alternative treatment for acid-related conditions.”

(Jennifer Abrams, MD, July 27, 2020)