Despite studies associating some risks with these heartburn helpers, an expert offers reassurance about long-term safety and usage.
Leslie Pepper,Jul 7, 2020 • 3 min read
For many with gastroesophageal reflux disease (GERD), proton pump inhibitors (PPIs) can be a lifesaver. They work by blocking a chemical system found in the cells of the stomach lining that produce stomach acid, relieving GERD symptoms. Common active ingredients include omeprazole (generic Prilosec), esomeprazole (generic Nexium), and lansoprazole (generic Prevacid), which can be bought over the counter; and rabeprazole (generic Aciphex), dexlansoprazole (generic Dexilant), and pantoprazole (generic Protonix), which require a prescription.
And they get the job done. According to Michael Goldberg, DO, chair of the Division of Gastroenterology at Einstein Healthcare Network, they can decrease stomach acid by about 60 percent, making them the most effective drugs for blocking stomach acid. Is it any wonder that Americans spend over $5 billion a year on PPIs?
Doctors generally prescribe PPIs long enough for patients to tweak their diet and lifestyle. In the best possible world, this negates the need for continuing medication. But some patients may require PPIs for longer. And in some cases, this can be life-saving. Literally for those with Barrett’s Esophagus, for instance, a condition in which the cells that line the lower part of the esophagus (called squamous cells) are replaced by another type of cell, (called columnar cells), high-dose PPI therapy for a lifetime may reduce the risk of a rare type of cancer.
PPIs taken over the long-term can also help prevent aspirin-induced gastroduodenal ulcers.
Here’s the rub: All drugs have a risk of side effects. The most commonly associated short-term side effects of PPIs are abdominal pain, diarrhea, headache, and nausea, occurring in about 1 to 2 percent of patients, says Dr. Goldberg. The good news: Often, patients can switch the PPI and the side effects abate. The not-so-good news: Some reports have questioned the safety of PPIs in the long term. The main concerns are possible risk of osteoporosis, bone fractures, dementia, pneumonia, increased gastrointestinal infections, and certain vitamin and mineral deficiencies. This has, not surprisingly, led to patient anxiety and some even tossing out their treatment, to the dismay of their doctors.
But these concerns may be unfounded. “The difficulty is many of the studies are just observational and don’t account for other variables that could alter the results,” says Dr. Goldberg. In other words, most of the research that has been done on PPIs look at the outcome after the treatment, without any manipulation from researchers. The studies may show that PPIs are associated with certain adverse effects, but they don’t necessarily cause those adverse effects. Study participants may have other issues that could affect their health status, such as smoking, being too thin, being a diabetic, drinking alcohol, etc.
So what’s the answer? “Take the lowest possible dose needed to control symptoms,” says Dr. Goldberg. And speak to your doctor about your individual risks versus the potential side effects. The esophagus is not designed to be exposed to excessive acid, so some people, like those with Barrett’s Esophagus, for example, will require life-long medication to control the damage acid can cause over the long term.