Proton pump inhibitors (PPIs) are a category of medications that reduce the amount of acid produced inside the stomach lining. By blocking the production of stomach acid, proton pump inhibitors can relieve the burning pain of acid reflux, and give the irritated or damaged tissue in the esophagus time to heal. Proton pump inhibitors are taken by millions of people in the United States and can provide relief for a range of acid reflux conditions including gastroesophageal reflux disease (GERD).
When it comes to conditions related to acid reflux, many terms are used interchangeably. Various conditions do share similar symptoms, but not all are the same. This can cause some confusion about what is normal, what requires medical attention, and what kind of treatment is appropriate. The confusion often results in an overuse of PPIs when they may not be necessary.
Heartburn is a burning sensation in the chest or throat after eating. It is typically temporary and can be treated with lifestyle changes. Heartburn occurs when the muscles between the esophagus and stomach do not function correctly. Stomach fluid is allowed to flow from the stomach back into the esophagus. This is called acid reflux. Again, almost everyone experiences this at some point. However, when the burning discomfort or pain occurs frequently and persistently, it is considered chronic and can progress into a serious disease called GERD.
Stomach acid that regularly flows into the esophagus and throat causes damage to the tissue of the esophagus and generally requires medication. PPI use doesn’t correct the muscle issue, but it does reduce the amount of acid in the stomach. This reduction in acid can help control acid reflux, and lower the damage that occurs in the tissue even when fluid flows back into the esophagus.
Proton pump inhibitors are very common medications, and you’ve likely heard their brand names in conversation or in advertisements. Nexium, Prevacid, and Prilosec are some of the most common brand name PPIs. These proton pump inhibitors are generally available both over the counter and by prescription. You may also find them labeled with their generic names instead of the brand names: lansoprazole (Prevacid 24 HR), omeprazole (Prilosec), and esomeprazole (Nexium). Other PPIs available by prescription include dexlansoprazole (Dexilant, Kapidex), pantoprazole sodium (Protonix), and rabeprazole sodium (Aciphex).
The majority of proton pump inhibitors function in a similar way, by blocking or reducing the production of acid in the lining of the stomach. There are some differences in factors like the time it takes the medication to work, how long the medication stays in your system, potential side effects, and cost. So you may want to ask your doctor about various options and the pros and cons of each. The underlying cause of your acid reflux may also influence which medication your doctor recommends, and what dose should be used.
Most proton pump inhibitors are taken by swallowing a pill or capsule. Liquid forms of certain PPIs are available for anyone who has trouble swallowing a pill. There are also other types of treatment for excess stomach acid besides proton pump inhibitors. These include a type of medication called H2 receptor blockers. Famotidine (Pepcid AC) and cimetidine (Tagamet) are medications in this category. However, PPIs are typically more effective and have results that last longer, so they are used more often than H2 receptor blockers.
Proton pump inhibitors are intended to be used for a short period of time. Generally, 4-8 weeks is long enough to help control heartburn or ulcers. When treating conditions like GERD, it’s important to make lifestyle changes as well. Lifestyle changes like quitting smoking, drinking less alcohol, losing weight, and elevating your head with a pillow while you sleep are all proven drug-free ways to improve the symptoms of acid reflux. However, sometimes medication is needed alongside lifestyle changes. Despite the risk of side effects, anyone who receives a diagnosis and prescription from their doctor should follow their doctor’s directions in order to prevent complications of acid reflux disease. If your condition doesn’t respond to lifestyle changes or medications, surgery may also be an option, but is usually a last resort.
Proton pump inhibitors can interact with other drugs. These interactions can cause changes in the effectiveness of both the proton pump inhibitor and/or the other medication. Different PPIs interact with different drugs, so it is important to talk with your doctor about all the medications you are taking before starting on a new PPI. Your doctor will be able to access all the risks and benefits of any drug interactions before you start taking a PPI. PPIs change the amount of acid in the stomach and intestines, which impacts digestion and absorption. These changes can impact how well another medication is absorbed. Especially with crucial drugs like blood thinners, a change in absorption can have a serious impact on your health.
PPIs are generally well tolerated by people taking them. However, everyone responds differently to different medications, and there are some side effects that are common in response to PPIs. These known side effects include headache, nausea, fever, abdominal pain, diarrhea or constipation, rash, flatulence, and vomiting.
When taken in high doses or for prolonged time periods, PPIs can have other side effects as well. One is an increased risk of bone fractures due to osteoporosis. These fractures are commonly seen in the wrist, hip, or spine. Long-term use of PPIs can also cause your body to absorb a lower amount of important nutrients, like vitamin B12 and magnesium. Less common but more serious side effects of PPIs can include an allergic reaction, and a reduced function in the liver, kidney, or pancreas. PPI use may also increase the risk of an infection of the colon called clostridium difficile (C. diff). That is why we recommend that long-term use be done under the supervision of a physician. Just because a medication is available over the counter, like PPIs, they are still powerful drugs.
While research is still underway, there have been studies linking long-term use of proton pump inhibitors with a risk of heart attack, as well as a higher risk of dementia. Scientists believe these correlations may occur because PPIs slow down the production of acid in all cells, not just those in the stomach. The changes throughout the body on a cellular level can have a broad impact on various aspects of health. The problem with most of the studies is that they were focused on elderly patients and do not account for other medications and health conditions.
Research still needs to be done to see if PPIs are the cause of these conditions, but anyone taking PPIs should be aware of the potential risks. Be sure to talk with your doctor about the risks and benefits of PPIs, as well as the lowest dose and shortest duration you can take in order to avoid these side effects. Despite ongoing research into side effects, PPIs have been proven as an effective and safe way to reduce acid reflux.
Remember that when GERD is left untreated, it can result in other serious issues such as ulcers, scarring, and even cancer. So proton pump inhibitors are an important tool for preventing discomfort and further complications. It is important to talk with your doctor and weigh all the pros and cons of your specific situation. Anyone who receives a diagnosis and prescription from their doctor should follow their doctor’s directions in order to prevent other serious complications of acid reflux disease.
At Carolina Digestive Health Associates, we have the doctors and resources to help you address any gastrointestinal concerns you may have, including treatment for acid reflux disease. Our fourteen board-certified gastroenterologists are ready to serve you at eight locations and five endoscopy centers throughout the Charlotte metropolitan area, as well as all local area hospitals. Book an appointment today.