PPI THERAPY CONTROVERSY

For more than 30 years, medications such as omeprazole (Prilosec and Zegerid), lansoprazole (Prevacid), pantoprazole (Protonix), rabeprazole (Aciphex), dexlansoprazole (Dexilant) and esomeprazole (Nexium) have been the go-to treatment for acid-related disorders of the digestive tract including gastroesophageal reflux disease (GERD) and peptic ulcer disease. Called proton pump inhibitors (PPIs), an estimated 15 million Americans use them — both prescription and over-the-counter varieties.

While acid contributes to the breakdown and digestion of food, sometimes it eats away at the protective mucous barrier that lines the digestive organs, causing ulcers, and can lead to heartburn or regurgitation.  A PPI taken 30-60 minutes before a meal dramatically reduces the acid production of certain cells in the stomach, giving a chance for ulcers to heal and reduce reflux.

In the past couple of years, some studies have raised concern about possible adverse effects of long-term PPI use. It’s a frightening list, including low magnesium, low vitamin D, stroke, Clostridium difficile (C. diff) infection, bone fractures, heart attacks, stomach cancer, pancreatic cancer, kidney disease and dementia. The quality of some of the studies are poor - this has been the case with dementia, heart attacks and pneumonia.

A common shortcoming of studies showing adverse effects from PPIs is that they are often observational studies. Unlike randomized controlled trials, observational studies can have distorted conclusions because of difficulty accounting for certain unmeasured variables.

A person who is obese, for example, is at an increased risk for reflux because their gut pushes on their stomach, causing the acid to create heartburn. An obese person also is more likely to have cardiovascular disease, so that increases their risk for heart attacks. So obesity is a confounding factor that may link PPI use to heart attacks. That said, known risks of PPIs can rarely include flatulence, diarrhea, headache, abdominal pain and nausea.

There is no reason a patient should be miserable in order to avoid these small, not-clearly-true risks. When PPIs are necessary, avoiding the medication could lead to pre-cancerous changes in the esophagus, ulcers and gastrointestinal bleeding. Some people might need to take PPIs over an extended period, possibly for life.

PPI THERAPY CONTROVERSY

For more than 30 years, medications such as omeprazole (Prilosec and Zegerid), lansoprazole (Prevacid), pantoprazole (Protonix), rabeprazole (Aciphex), dexlansoprazole (Dexilant) and esomeprazole (Nexium) have been the go-to treatment for acid-related disorders of the digestive tract including gastroesophageal reflux disease (GERD) and peptic ulcer disease. Called proton pump inhibitors (PPIs), an estimated 15 million Americans use them — both prescription and over-the-counter varieties.

While acid contributes to the breakdown and digestion of food, sometimes it eats away at the protective mucous barrier that lines the digestive organs, causing ulcers, and can lead to heartburn or regurgitation.  A PPI taken 30-60 minutes before a meal dramatically reduces the acid production of certain cells in the stomach, giving a chance for ulcers to heal and reduce reflux.

In the past couple of years, some studies have raised concern about possible adverse effects of long-term PPI use. It’s a frightening list, including low magnesium, low vitamin D, stroke, Clostridium difficile (C. diff) infection, bone fractures, heart attacks, stomach cancer, pancreatic cancer, kidney disease and dementia. The quality of some of the studies are poor - this has been the case with dementia, heart attacks and pneumonia.

A common shortcoming of studies showing adverse effects from PPIs is that they are often observational studies. Unlike randomized controlled trials, observational studies can have distorted conclusions because of difficulty accounting for certain unmeasured variables.

A person who is obese, for example, is at an increased risk for reflux because their gut pushes on their stomach, causing the acid to create heartburn. An obese person also is more likely to have cardiovascular disease, so that increases their risk for heart attacks. So obesity is a confounding factor that may link PPI use to heart attacks. That said, known risks of PPIs can rarely include flatulence, diarrhea, headache, abdominal pain and nausea.

There is no reason a patient should be miserable in order to avoid these small, not-clearly-true risks. When PPIs are necessary, avoiding the medication could lead to pre-cancerous changes in the esophagus, ulcers and gastrointestinal bleeding. Some people might need to take PPIs over an extended period, possibly for life.

PPI THERAPY CONTROVERSY

For more than 30 years, medications such as omeprazole (Prilosec and Zegerid), lansoprazole (Prevacid), pantoprazole (Protonix), rabeprazole (Aciphex), dexlansoprazole (Dexilant) and esomeprazole (Nexium) have been the go-to treatment for acid-related disorders of the digestive tract including gastroesophageal reflux disease (GERD) and peptic ulcer disease. Called proton pump inhibitors (PPIs), an estimated 15 million Americans use them — both prescription and over-the-counter varieties.

While acid contributes to the breakdown and digestion of food, sometimes it eats away at the protective mucous barrier that lines the digestive organs, causing ulcers, and can lead to heartburn or regurgitation.  A PPI taken 30-60 minutes before a meal dramatically reduces the acid production of certain cells in the stomach, giving a chance for ulcers to heal and reduce reflux.

In the past couple of years, some studies have raised concern about possible adverse effects of long-term PPI use. It’s a frightening list, including low magnesium, low vitamin D, stroke, Clostridium difficile (C. diff) infection, bone fractures, heart attacks, stomach cancer, pancreatic cancer, kidney disease and dementia. The quality of some of the studies are poor - this has been the case with dementia, heart attacks and pneumonia.

A common shortcoming of studies showing adverse effects from PPIs is that they are often observational studies. Unlike randomized controlled trials, observational studies can have distorted conclusions because of difficulty accounting for certain unmeasured variables.

A person who is obese, for example, is at an increased risk for reflux because their gut pushes on their stomach, causing the acid to create heartburn. An obese person also is more likely to have cardiovascular disease, so that increases their risk for heart attacks. So obesity is a confounding factor that may link PPI use to heart attacks. That said, known risks of PPIs can rarely include flatulence, diarrhea, headache, abdominal pain and nausea.

There is no reason a patient should be miserable in order to avoid these small, not-clearly-true risks. When PPIs are necessary, avoiding the medication could lead to pre-cancerous changes in the esophagus, ulcers and gastrointestinal bleeding. Some people might need to take PPIs over an extended period, possibly for life.