What are Proton Pump Inhibitors?

What are Proton Pump Inhibitors?

Proton Pump Inhibitors (PPI) are medications that are frequently used in the treatment of gastroesophageal reflux symptoms. These symptoms may include, but are not limited to:

• Heartburn
• Hiccups
• Difficulty Swallowing
• Nausea

PPIs work by inhibiting stomach acid secretion, reducing the acidity of stomach acid, which may help alleviate some of the aforementioned symptoms. PPIs differ from other heartburn type medications in that they must be taken on a daily to receive the most benefit, as opposed to taking them only when symptoms occur. Although PPIs can be purchased over the counter (OTC) for the treatment of heartburn-like symptoms, they are often prescribed in hospitals and clinics to prevent or promote the healing of stomach ulcers.

Commonly used Proton Pump Inhibitors

Why are they bad long term?¹

PPIs are indicated to be used for a short period of time to promote the healing of stomach ulcers or the prevention of new ulcers. A common scenario that occurs involves patients that are prescribed these medications while in the hospital and are not appropriately taken off of the medication at discharge, leading to unnecessary cost and pill burden for patients. However, more recently, long-term PPI use has been associated with many other serious effects:

• Anemia
• Osteoporosis
• CKD
• B12 deficiency
• Vitamin B deficiency
• Clostridium difficile associated diarrhea
• Pneumonia

When should you be concerned?

Although the current evidence does not suggest PPIs are the sole cause of some of these adverse effects, their association should serve as a wake-up call for patients and health care professionals to question the long-term use of these medications.

In addition to having routine check-ups, it is important to contact your primary care physician or gastroenterologist if you experience any of the following:

• Dark-Tarry Stools
• Fatigue
• Cramping
• Muscle Spasms
• Diarrhea
• Abdominal Pain
• Continued Heartburn Symptoms Despite Treatment.

Things you can try at home:^2,3

While PPIs are generally well tolerated, current standards of practice suggest using PPIs with the following mantra in mind: Lowest effective dose. Shortest Duration possible.

In order to facilitate this goal, the following methods are also recommended for patients who suffer from gastroesophageal reflux symptoms:

1. Lifestyle Modifications - losing weight and eliminating certain trigger foods (caffeine, acidic foods, carbonated drinks, fatty foods) may help to reduce heartburn symptoms.
2. Elevation of the head - placing books underneath your pillow or using a foam wedge to elevate the head can help prevent acid from traveling up your esophagus which may be the cause of your discomfort
3. Avoiding late and large meals - Avoiding laying down for 2-3 hours after a meal or before bedtime. Additionally, reducing the amount of food ingested at one time may help with symptoms.

As always, it is important to reevaluate the continued need of any medication that you may be taking. Be sure to bring your most up to date medication list with you to all of your check-ups and pharmacy visits.

Citations:

1. Nehra AK, Alexander JA, Loftus CG, Nehra V. Proton Pump Inhibitors: Review of Emerging Concerns. Mayo Clin Proc. 2018;93(2):240-246.
2. Devault KR, Castell DO. Updated guidelines for the diagnosis and treatment of gastroesophageal reflux disease. Am J Gastroenterol. 2005;100(1):190-200.
3. Ness-jensen E, Hveem K, El-serag H, Lagergren J. Lifestyle Intervention in Gastroesophageal Reflux Disease. Clin Gastroenterol Hepatol. 2016;14(2):175-82.e1-3.