At some time or another, we’ve all been there. Whether one too many coffees, grandma’s homemade marinara sauce or a really indulgent holiday meal, now you’re reaching for some heartburn relief.
If you are like millions of Americans who suffer from gastroesophageal reflux disease (GERD), a digestive disorder, or other acid reflux disorders, you may reach for “the purple pill” or other similar proton pump inhibitors (PPIs) to relieve that burning pain in your lower chest.
But recent studies have raised some questions about the serious and even life-threatening side effects of these drugs. Are PPIs more harmful than helpful when it comes to treating GERD?
The good news is that in most occasional cases of heartburn, you probably won’t need these medications. But if it becomes a recurring problem and diet and over-the-counter antacids, such as Rolaids and Tums, aren’t doing the trick, what should you take?
“Short-term medication is definitely helpful when it comes to symptom relief, but usually this relief is temporary, and the symptoms usually return after stopping the medication,” said Khoi Dinh Le, MD, a general and robotics surgeon at Banner Health Clinic in Greeley, CO. “The general research consensus is that GERD is more prominent in those who are obese. However, dietary and lifestyle modifications, with the aim of losing weight in a healthy and long-lasting manner, can minimize or even eliminate reflux and heartburn.”
GERD is more prominent for obese people, because they have less space within their abdominal cavity. So anywhere or any direction pressure can be released is what the body will tend to do. This can manifest in the form of belly button or groin hernias, shortness of breath, exercise intolerance, hiatal hernias, and heartburn.”
If you’ve exhausted all short-term measures and weight loss but are still experiencing GERD, Dr. Le explains the pros and cons of taking PPIs long-term.
Weighing the pros and cons
PPIs work by blocking and decreasing the production of stomach acid and giving a chance for damaged tissue in your esophagus time to heal. They are found over-the-counter or by prescription. Generally, PPIs are intended for short-term use (4-8 weeks) to help control heartburn and ulcers.
The pros of PPIs
If you overproduce acid, you are at a higher risk of developing peptic ulcers, where the acid overcomes the protective mechanisms of the stomach, leading to erosion and subsequently ulcers. Ulcers, if left untreated, can actually lead to perforation, causing you to become sick or septic—a surgical emergency, should this happen.
Short-term use of proton pump inhibitors is helpful in healing ulcers, when used in conjunction with certain antibiotics and other medications.
“For GERD and heartburn, PPIs can be helpful with treating symptoms when they become particularly inhibiting or bothersome,” Dr. Le said. “They can also help your doctor or surgeon determine if certain types of surgeries or procedures will help eliminate GERD. If, after 6-8 weeks of therapeutic PPI treatment, your symptoms return, you might be a candidate for surgery.”
Other medications, such as H-2 blockers (Zantac, generic: ranitidine), block an alternative pathway of acid production. However, as recently as March 2020, the Food and Drug Administration has requested the immediate removal of Zantac from the market due to risk of cancer with long term use of this drug.
The cons of PPIs
While PPIs are generally well tolerated by people, everyone can respond differently, and there are some not so pleasant side effects that are common in response to them. These include headache, nausea, fever, diarrhea or constipation and vomiting.
Fractures
Long-term, PPIs are associated with a greater risk of infections, certain conditions and vitamin deficiencies. One is an increased risk of bone fractures in the wrist, hip or spine.
“This is because long-term use can cause your body to absorb a lower amount of important nutrients, like vitamin B12, iron, calcium and magnesium,” Dr. Le said. “Although in many cases, a supplement can help correct nutrient deficiencies.”
Medication interactions
Some PPIs can interact with common prescription drugs, such as blood thinners. If you take any over-the-counter or prescription PPIs, make sure you talk to your doctor about whether it’s safe to take both together.
“In general, the stomach wants to maintain a specific pH or acidity level,” Dr. Le said. “Absorption of many medications, nutrients, vitamins and minerals, begins with digestion in the stomach. Changing the pH level within the stomach can cause problems with absorption of these nutrients. Some of these problems can be unpredictable and can make certain medications more or less effective.”
Infection risk
New evidence has emerged that PPIs have been associated with a greater risk of infections such as pneumonia and C-diff diarrhea.
“Many adults diagnosed with adult onset asthma often have GERD or heartburn that can be easily overlooked as a reason,” Dr. Le said. “This is because chronic reflux can lead to aspiration, where small amounts of acid and other stomach contents are accidentally inhaled into the lungs, causing chronic scarring and asthma-like symptoms. If the acid level of the stomach is reduced by medication to help with symptoms of heartburn, the natural bacteria-killing effect of this acid is reduced. This allows for bacteria to grow within the stomach and then become inhaled into the lungs during episodes of reflux, leading to infection of the lungs, better known as pneumonia.”
C. difficile is a naturally occurring bacteria typically residing in your colon. There is a delicate balance of “good” and “bad” bacteria (C. diff is a bad kind of bacteria generally). When in balance, your GI tract functions normally. But if for some reason this balance is shifted or tipped in the wrong direction, “bad” bacteria can overgrow causing an infection.
“There is some evidence that chronic use of PPIs can lead to C. diff diarrhea by a similar mechanism as pneumonia,” Dr. Le said. “The acid in the stomach is reduced, allowing overgrowth of certain bacteria, or not neutralizing any bacteria ingested with meals, which can travel through the gut and disrupt the delicate bacterial balance in the colon, leading to infection.”
Should I still consider a PPI?
Research still needs to be done to see if PPIs are the cause of these conditions, but anyone taking them should be aware of the potential risks and discuss the pros and cons with their doctor.
When starting a PPI, Dr. Le recommends starting at the lowest dose and not abruptly stopping if you’ve been taking a PPI for quite some time.
Big takeaway
If GERD is left untreated, it can result in some serious issues, such as ulcers, scarring, problems swallowing and even cancer. While there are some long-term risks associated with them, PPIs are still an important tool for preventing discomfort and further complications.
“Now that PPIs have been out for decades, we’re starting to see more and more patients develop problems from taking them long-term,” Dr. Le said. “Permanently taking medication may not be the right answer for everyone, and other options such as surgery or endoscopic treatments are available. Talk to your doctor to weigh the pros and cons.”
To find a doctor, visit bannerhealth.com.
