Should I be on a PPI Long-term?

Millions of people live with the symptoms of heartburn or acid reflux. These are some of the most common digestive health conditions that can produce a burning sensation in the esophagus or back of the throat, a sour taste in the mouth, and general gastrointestinal (GI) discomfort oftentimes after eating certain foods or a large meal.

If any of these symptoms last for more than a few weeks and become chronic, your gastroenterologist may prescribe a medication called a proton pump inhibitor, also known as a PPI. Common PPI names include Omeprazole, Esomeprazole, Lansoprazole and Pantoprazole.

PPIs are a class of medications that work by blocking or inhibiting an enzyme called the proton pump from producing stomach acid. PPIs are available by prescription and over the counter and work very well in reducing heartburn, other symptoms of acid reflux, and gastroesophageal reflux disease (GERD).

Read on to learn more how PPIs can help relieve symptoms, how they’re prescribed, tips for taking them and much more.

What do PPIs do/what are they prescribed for?

PPIs work to decrease the acid production in the stomach which reduces discomfort from symptoms of acid reflux, as well as aids in the healing of ulcers and damage caused by GERD called esophagitis.

PPIs combined with antibiotics can be used to treat a stomach infection called H. Pylori. Barrett’s esophagus is the result of repeated acid exposure in chronic GERD which is associated with an increased risk of developing esophagus cancer, and long-term PPI use can help to prevent progression to esophageal cancer.

What’s the difference between prescribed PPIs and over-the-counter PPIs?

Certain PPIs and dosages are available as over the counter (OTC) and some are available by prescription only.

For example, Prilosec (Omeprazole) 20mg, Nexium (Esomeprazole) 20mg and Prevacid (Lansoprazole) 15mg are available OTC.

Larger doses of these medications and other brands are available by prescription: Prilosec 40mg, Nexium 40mg, Prevacid 30mg, Protonix (Pantoprazole) 20mg and 40mg, Dexilant (Dexlansoprazole) 30mg and 60mg, and Aciphex (Rabeprazole) 20mg.

How long can I take PPIs? Is there risk to taking them long-term?

PPIs are some of the most widely prescribed medications in the world, as they are effective and have an overall good safety profile.

PPIs are usually prescribed for approximately 12 weeks but individuals who have certain conditions such as Barrett’s esophagus or eosinophilic esophagitis, or use anti-inflammatory medication (ibuprofen, acetaminophen, etc.) regularly may have to take PPIs on a long-term basis.

In addition, PPIs are often continued longer in patients who have chronic GERD symptoms who have not responded to weight loss, dietary, or lifestyle modifications.

Studies on long-term PPI use have gained increased attention because of possible associations with vitamin deficiencies, small intestinal bacterial overgrowth, kidney disease, decreased bone density and dementia. However, many of these studies have been criticized because they don’t demonstrate a direct cause and effect between PPIs and these potential side effects.

For example, a small study suggested a connection between PPI use and dementia. Subsequent and higher-quality studies did not find an association between PPI use and dementia, though these did not receive as much attention as the initial study. Patients who are on long-term PPI treatment for a valid reason should not stop taking the medication because of concerns about dementia risk.

To reduce any side effects, it is best to take PPIs at the lowest-possible dose, for the shortest amount of time. Some common short-term side effects of PPIs are headaches, nausea, constipation, diarrhea and rash. If these occur, speak with your gastroenterologist or prescribing provider for recommendations on discontinuation and alternatives.

When should PPIs be taken?

PPIs work very well in treating and preventing symptoms; however, they are commonly taken incorrectly. PPIs must be taken 30 to 60 minutes before eating a meal so the PPI can start working to shut down the acid pumps, prior to acid being released after eating.

Are there alternatives to PPIs?

In addition to PPIs, there is also another class of medications called H2 receptor blockers, which include Famotidine (Pepcid), Cimetidine (Tagamet), and Ranitidine (Zantac). H2 receptor blockers work to inhibit acid production in a different mechanism than PPIs. H2 blockers work quicker than PPIs but have a shorter duration of benefit, often have to be taken twice daily, and may lose effectiveness if taken for extended periods of time.

The H2 receptor blocker Ranitidine (Zantac) was recently removed from the market and is no longer available for use. Antacids such as Tums can also be used to treat symptoms.

Initial management of mild reflux symptoms can include antacids as needed, H2 receptor blockers as needed and dietary/lifestyle modifications. If as-needed medication does not improve symptoms, H2 receptor blockers can be used one to two times per day. If symptoms persist, your provider may discontinue the H2 blocker and prescribe a low-dose PPI available over the counter to be taken 30 to 60 minutes before a meal for two weeks.

PPIs and H2 receptor blocks should not be taken at the same time because the H2 receptor block can interfere with the effectiveness of PPIs.

What other steps can be taken to reduce heartburn/reflux?

While acid-reducing medications such as H2 blockers and PPIs work well in treating heartburn, reflux, and GERD symptoms, there are many diet and lifestyle modifications that should be the first line of treatment. Those include:

1. Weight loss
2. Sleeping with the head of bed elevated
3. Avoiding meals two to four hours before bedtime
4. Avoiding specific foods that trigger reflux including chocolate, caffeine and alcohol
5. Acidic or spicy foods should be limited or avoided

It is also essential to stop using tobacco for many health reasons but especially if you have heartburn and reflux symptoms. Tobacco relaxes the area between the esophagus and the stomach, known as the lower esophageal sphincter. When the sphincter relaxes, it allows stomach acid to back up or reflux into the esophagus, which causes heartburn.

Acid reflux is a common condition that can be effectively treated with a variety of lifestyle measures, and medications, including PPIs. There are options to successfully help with the management of heartburn, reflux and GERD symptoms. It is important to discuss your symptoms and concerns with your doctor to develop a personal treatment plan that is right for you.

Call us at 815-397-7340 or make an appointment online. A referral is often not needed.