by Dr. Quinn Rivet, B.Sc., ND

“Heartburn” is so common that in 2013, it is estimated that 112 million prescriptions for a class of drugs used for stomach acid control, known as Proton Pump Inhibitors or PPI for short, were written worldwide, 26 million in the US alone.

The drug (Proton pump inhibitors) do work well at inhibiting acid production and do provide relief for acid indigestion, however, studies investigating the long term use of the medication have revealed some startling findings.  Concerns about this class of medication started as far back as 1998 and recent reviews have demonstrated that long-term use can contribute to chronic kidney disease, bone weakening and fractures, nutritional deficiencies like B12 and magnesium, increased intestinal infections, and most unfortunate is the possibility of PPIs contributing to brain disease in those using the medication who are over 75.

“We Have a Problem Houston”

Stopping the medication is not that easy. For individuals that have been on the medication for some time and who attempt to come off the medication tend to get something known as “rebound hyperacidity” which means  that when the stomach initially starts to make its own acid, it has a tendency to make a fare bit. The other problem is that the stomach now has a history of consistently low acid, certain stomach lining protection systems are not running at full steam because of this, so when the stomach increases its acid production the stomach gets irritated and the symptoms come back and are very uncomfortable. So the tendency is to keep taking the pill.

The government of Canada issued its recommendations based on its consulting in a post in 2014.

The recommended dosage to be 20mg/day of for 2 weeks with no repeats for 4 months. So no more than 3 prescriptions per year. Speak with your medical doctor if you have concerns about dosing.

There are other options, another class of drugs known as the H2 blockers may be helpful for those who have serious health issues and need strong medicine. Simple dietary changes like stopping coffee, black tea, decreasing bad fats, and avoiding rich packaged foods can make a world of difference. The herbs slippery elm, marshmallow root, dandelion root, and licorice root have been used to help with stomach acid irritation.

“Heartburn” can result from many different conditions ranging from heart disease, stomach ulcers, liver problems, hiatal hernias, or certain medications. Most of the time, however, it is typically a benign functional issue that can be aided by simple diet, exercise and stress reduction applications. The doctors here at the clinic treat a variety of digestive issues and for those who have heartburn or wish to investigate if they qualify to come off their proton pump inhibitor please feel free to contact the clinic.

Examples of Proton Pump inhibitors (PPI’s)

  • Meprazole (Prilosec, Prilosec OTC)
  • Lansoprazole (Prevacid, Prevacid 24-Hour)
  • Dexlansoprazole (Dexilent, Kapidex)
  • Rabeprazole (Aciphex)
  • Pantoprazole (Protonix)
  • Esomeprazole (Nexium)
  • Zegarid, a rapid release form of omeprazole.e

If you are on a proton pump inhibitor (PPI) and have been on it for some time please speak to your medical doctor and see if you should discontinue it and explore other options.

References

1998

  • Garnett, WR. Considerations for long-term use of proton-pump inhibitors. Am J Health Syst Pharm.1998 Nov 1;55(21):2268-79.

2000

  • Laine, l. et. al. Review article: potential gastrointestinal effects of long-term acid suppression with proton pump inhibitors. Aliment Pharmacol Ther.2000 Jun;14(6):651-68.

2002

  • Waldum, HL et. al. Long-term safety of proton pump inhibitors: risks of gastric neoplasia and infections. Expert Opin Drug Saf.2002 May;1(1):29-38.

2008

  • Proton pump inhibitors and an emerging epidemic of gastric fundic gland polyposis. World J Gastroenterol. 2008 Mar 7; 14(9): 1318–1320.
  • Cunningham, et al. Is over-use of proton pump inhibitors fuelling the current epidemic of Clostridium difficile-associated diarrhoea? J Hosp Infect.2008 Sep;70(1):1-6.
  • Aseeri, M. et al.Gastric acid suppression by proton pump inhibitors as a risk factor for clostridium difficile-associated diarrhea in hospitalized patients. Am J Gastroenterol.2008 Sep;103(9):2308-13.

2009

  • Ali, T, et al. Long-term safety concerns with proton pump inhibitors. Am J Med.2009 Oct;122(10):896-903.

2010

2011

  • Bavishi, C. et al. Systematic review: the use of proton pump inhibitors and increased susceptibility to enteric infection. Aliment Pharmacol Ther.2011 Dec;34(11-12):1269-81.

2012 

  • Roulet, L. et al. Adverse effects of proton pump inhibitors: should we worry about long-term exposure? Rev Med Interne.2012 Aug;33(8):439-45.
  • Janarthanan, S. et al. Clostridium difficile-associated diarrhea and proton pump inhibitor therapy: a meta-analysis. Am J Gastroenterol.2012 Jul;107(7):1001-10.

2013

  • Maggio, M, et al. Proton pump inhibitors and risk of 1-year mortality and rehospitalization in older patients discharged from acute care hospitals. JAMA Intern Med.2013 Apr 8;173(7):518-23.
  • Fashner, J. et al. Common gastrointestinal symptoms: risks of long-term proton pump inhibitor therapy. FP Essent.2013 Oct;413:29-39.

 2014

2015

  • Hah, NH., et al. Proton Pump Inhibitor Usage and the Risk of Myocardial Infarction in the General Population. Published: June 10, 2015. http://dx.doi.org/10.1371/journal.pone.0124653.
  • Haenisch, B. et al. Risk of dementia in elderly patients with the use of proton pump inhibitors. Eur Arch Psychiatry Clin Neurosci.2015 Aug;265(5):419-28.
  • Akter,S. et al. Cognitive impact after short-term exposure to different proton pump inhibitors: assessment using CANTAB software. Alzheimers Res Ther.2015 Dec 27;7(1):79.

2016

Xie Y., et al. Proton Pump Inhibitors and Risk of Incident CKD and Progression to ESRD. JASN April 14, 2016.