Risks of Common Heartburn Meds

They are known by gastroenterologist‎s as “proton pump inhibitors,” or PPIs, and though their clinical name sounds somewhat complex, their mission is quite basic: reduce the amount of stomach acid that causes heartburn or “reflux.”

When antacids aren’t enough, these PPIs — more commonly known by brand names such as Nexium, Prilosec and Prevacid — can reduce symptoms of indigestion, heartburn or GERD (gastro-esophageal reflux disease), a chronic digestive disease.

PPIs have been available over-the-counter for years, and they are heavily promoted through TV and Internet ads. This exposure has helped make PPIs one of the most popular non-prescription meds in the U.S.

But there are risks associated with the overuse of PPIs as several studies have concluded. PPIs appear to elevate the chance of developing chronic kidney disease, according to a new study involving more than 250,000 people.

When PPIs were first approved in the 1980s, there was little evidence of possible health risks. Since then, concerns have been raised, although no study, including the newest one regarding kidney disease, has found a direct “cause and effect” relationship between PPIs and a particular health condition. Nonetheless, studies have shown that PPIs may increase the risk for a variety of problems, including bone fractures, infections and possibly even heart problems.

Don’t Use PPIs When Antacids Will Do

PPIs shouldn’t be taken instead of simple and harmless antacids, says Jeffrey Schneider, M.D., a gastroenterologist at the Baptist Endoscopy Center at Coral Springs.

“I always tell patients that less is better,” says Dr. Schneider. “If you watch the TV ads, then you probably get the idea that these meds are a good way of avoiding heartburn. They make it seem like it’s okay for you to have fast food or a pizza. But PPIs don’t work like that. Many times, you’re better off taking antacids and not relying on PPIs.”

People with regular heartburn or GERD should consult with their primary doctor or a gastroenterologist for the proper dosage of PPIs. Those over-the-counter heartburn meds come in different doses, but they are generally for use over a 14-day or less period. Any prolonged use of PPIs should be under the strict guidance of your doctor.

Dr. Schneider points out that there are many people who do require PPIs, and these studies may scare them away from something they really need. GERD is a result of a weak esophageal sphincter. That weakness allows the contents of your stomach to flow back up into your esophagus.

The True Role of PPIs

The consequences of not taking these meds if you need them can be serious. One result can be long-term inflammation of the esophagus (esophagitis), which increases the risk of pre-cancerous cells in the esophagus. Severe cases of GERD can lead to a condition called Barrett’s esophagus. That’s when your esophagus grows tissue resembling the tissue found in the lining of your intestine.

“The media buzz and attack on PPIs are almost non-stop,” says Dr. Schneider. “They say they could cause bone fractures, low magnesium or even heart attacks, but there is no bottom-line cause and effect.  If you have a good reason to regularly use PPIs, then you should be using them.”

In the United States, approximately 20 percent of the population has GERD, according to the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK).

Lifestyle Changes

There are lifestyle changes that can help individuals who suffer from GERD, and possibly get them off the meds permanently.

• Lose weight if you are overweight: Excess weight can be a major factor in GERD cases. The frequency of acid reflux has increased along with the U.S. obesity rate.
• Wear loser clothing: Tight clothing can put pressure on your stomach.
• Manage or reduce stress: Stress is a factor in stomach disorders, including heartburn and GERD.
• Reduce alcohol and caffeine in your diet, and quit smoking: These three habits can cause acid reflux by weakening or relaxing the sphincter that closes the junction between the esophagus and stomach. Remember, a weak esophageal sphincter can cause stomach contents to go backwards.
• Avoid foods that worsen GERD: These include fatty or greasy foods, carbonated beverages, citrus (both fruit and beverages), and spicy foods.
• Eat smaller meals: Big meals tend to fill the stomach too much, creating an easier environment for acid reflux.
• Stay upright after eating: Gravity can help the stomach contents from moving in the wrong direction. When you lie down, it makes it hard for digestion to progress towards the small intestine. So, it is best to allow several hours after eating a meal before going to sleep.