Abstract
Long-term use of proton pump inhibitors (PPIs) is common in patients with muscle wasting-related chronic diseases. We explored the hypothesis that the use of PPIs may contribute to a reduction in muscle mass and function in these patients. Literature indicates that a PPI-induced reduction in acidity of the gastrointestinal tract can decrease the absorption of, amongst others, magnesium. Low levels of magnesium are associated with impaired muscle function. This unwanted side-effect of PPIs on muscle function has been described in different disease backgrounds. Furthermore, magnesium is necessary for activation of vitamin D. Low vitamin D and magnesium levels together can lead to increased inflammation involved in muscle wasting. In addition, PPI use has been described to alter the microbiota’s composition in the gut, which might lead to increased inflammation. However, PPIs are often provided together with nonsteroidal anti-inflammatory drugs (NSAIDs), which are anti-inflammatory. In the presence of obesity, additional mechanisms could further contribute to muscle alterations. In conclusion, use of PPIs has been reported to contribute to muscle function loss. Whether this will add to the risk factor for development of muscle function loss in patients with chronic disease needs further investigation.
Highlights
A consensus definition has been proposed by Evans and colleagues: “Cachexia is defined as a loss of lean tissue mass, involving weight loss greater than 5% of body weight in 12 months or less in the presence of chronic illness or as a body mass index (BMI) lower than 20 kg/m2
We focus on the possible effects of pump inhibitors (PPIs) use on magnesium levels and vitamin D metabolism, which may impact inflammatory processes in the body that are relevant in the development of muscle mass and function loss in chronic illnesses [46] and on alterations in the gut microbiota [12]
We hypothesized that long term use of proton pump inhibitors contributes to an increase in symptoms of cachexia and sarcopenic obesity in patients with chronic illness
Summary
Weight and muscle loss are reversible when adequate amounts of energy and protein are provided. In cachexia this is not the case [6]. Mortality rates of patients are disease-dependent and range from 15% up to 80% [6]. It is only recently that it has become apparent that preservation of only muscle mass without improving muscle function has no effect on quality of life and mortality rates in cancer patients [9]. Loss of muscle function is contributing to a higher extent to morbidity and mortality than loss of muscle mass. Because most chronically ill patients are older people, this further strengthens the importance of muscle function in the chronically ill patient population
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