Proton pump inhibitors (PPIs) are medications that suppress the production of stomach acid.  They are prescribed for people with stomach or duodenal pain from ulcers or inflammation.  They also treat gastroesophageal reflux, the passage of stomach acid into the esophagus.  Acid reflux can cause burning or pain in the chest, an acid taste in the mouth, or coughing due to acid inhalation into the lungs.

Proton pump inhibitors are usually over the counter drugs and do not require a written prescription.  Common names are Nexium, Prilosec, and Protonix.  They are not safe over the long term.  They are over –prescribed by physicians, and the majority of people taking them are doing so inappropriately.

PPIs have many long-term side effects:

1. Absence of stomach acid allows proliferation of bacteria that would otherwise be killed.  This includes clostridium difficile, which causes severe diarrhea and is difficult to eradicate.  C. difficile diarrhea is one of the major complications of being in the hospital, but is also common in outpatients, especially those taking antibiotics.

2. They increase risk of osteoporosis.  There is impaired absorption of  calcium, vitamin D, vitamin C and magnesium, which are important in forming new bone.  PPIs lead to more bone fractures.

3. There is also malabsorption of vitamin B12 and iron, leading to anemia and neurologic problems.

4. They increase small intestinal bacterial overgrowth (SIBO), again due to excess bacterial passage into the small intestine.  SIBO causes abdominal pain and gas.

5. They raise the risk of heart attacks, partly by suppressing production of nitric oxide, a nutrient that increases blood flow by dilating arteries.

6. They speed the development of kidney disease.  Patients taking PPIs have nearly twice the risk of developing kidney failure.

7. They impair brain function, including memory, attention, and decision making.  They may speed the development of Alzheimer disease.

Talk to your physician about stopping PPI use.  Sometimes there is reflex overproduction of stomach acid leading to recurrence of symptoms when these medications are stopped, so any changes must be done under the care of a doctor. We use natural supplements that are often effective in managing stomach pains and reflux, such as glutamine, aloe vera and licorice.  They can be taken indefinitely without side effects.

Avoid alcohol, aspirin unless you have heart disease, caffeine, and cigarettes, all of which increase stomach and esophageal symptoms. Eat smaller meals, eat more slowly and chew food thoroughly.  Avoid spicy foods. Lose weight if you are overweight.  This will lessen reflux. Do not eat within 3 hours of going to bed.  This also lessens reflux.

-Allan Sosin MD

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