Proton pump inhibitors (PPIs) are used widely in the management of acid-related disorders and, for the majority of patients, oral therapy is effective. Proton pump inhibitors have enabled improved treatment of various acid-peptic disorders, including gastroesophageal reflux disease, peptic ulcer disease, and nonsteroidal anti-inflammatory druginduced gastropathy. If you would like to receive a free email newsletter on natural health and medicine, see Newsletter. See also this informative page gerd diet.
Types of Proton Pump Inhibitors
The
proton pump inhibitors omeprazole, lansoprazole, rabeprazole, and
esomeprazole appear to have similar efficacy.
Omeprazole (Prilosec)
Lansoprazole (Prevacid)
Rabeprazole (Aciphex)
Pantoprazole (Protonix)
Esomeprazole (Nexium)
Long Term Proton
Pump Inhibitor Use
Omeprazole began to be used in 1988, and since
then proton-pump inhibitors have remained central to the management of
acid-suppression disorders and are unchallenged with regard to their
popularity among doctors and patients. They were considered safe but there
are some concerns about the possibility of an association with cancer,
infection, and gastric atrophy; current concerns about long-term
proton-pump inhibitor therapy are centred mainly on a possible association
with fundic gland polyps and between Helicobacter pylori and gastric
atrophic changes. Long-term proton-pump inhibitor usage accounts for the
majority of the total proton-pump inhibitor usage. Long-term usage is
difficult to define and most patients take proton-pump inhibitors
non-continuously. Data indicate that a substantial proportion of long-term
users do not have a clear indication for their therapy and there is thus
room for reduction or rationalization of treatment. Overall, on-demand
therapy is more cost-effective than continuous therapy and should be
considered wherever possible.
Heartburn Medication May not
be Safe
-- Side effects of proton pump inhibitor drugs
Proton-pump inhibitors that
block stomach acid production increase the risk of an increasingly common
infectious form of diarrhea. Taking a heartburn medication such as AstraZeneca's Nexium
or Losec or their generic versions significantly increases the risk of
diarrhea blamed on the Clostridium difficile bacteria. Frequently
prescribed anti-heartburn drugs called H2 antagonists that include
GlaxoSmithKline's Zantac double the risk of the bacterial
diarrhea. PPIs and H2 antagonists reduce gastric acid, allowing for bacteria to multiply
in the digestive system. Clostridium is the third-most common type of
infectious diarrhea in patients aged 75 and older. Exposure to Clostridium difficile
bacteria, which causes infection and inflammation of the intestine,
previously occurred mostly during hospital stays, but cases have
increasingly been contracted in community settings. While antibiotics
formerly blamed for outbreaks of the illness have declined in use, the
acid-blocking drugs have become steadily more popular to treat ulcers and
conditions such as gastric reflux disease.
Hip fracture risk
increased with proton pump inhibitors
long-term use of proton pump inhibitors increases the risk of hip
fractures in adults over 50.
GERD disease and proton
pump inhibitors - acid reflux
Drugs such as Nexium and Prilosec, referred to as proton pump inhibitors,
are effective treatments for gastroesophageal reflux. But when these drugs
fail to bring relief, persistent heartburn may be the result of an
increase in non-acidic reflux. Gastroesophageal reflux disease, or ( GERD
), occurs when fluid in the stomach, which is highly acidic, moves into
the esophagus, typically causing heartburn. Because of the change in body
position, reflux is often worse during sleep. Persistent reflux can cause
permanent changes in the lining of the esophagus, which can lead to
cancer. Dr. Suanne Goodrich and her associates at the Lynn Health Science
Institute in Oklahoma City point out that the role of non-acid reflux
during sleep has not been evaluated. They theorized that non-acidic reflux
during sleep could cause prolonged esophageal exposure to bile salts and
pancreatic enzymes, and increase the risk of inhalation of the reflux
fluid. Fifteen subjects with heartburn were randomly assigned to treatment
with the proton pump inhibitor Nexium (esomeprazole) or to inactive
"placebo" for 1 week. After the week of treatment, the subjects spent a
night in the researchers' lab, where they underwent various reflux tests.
Prior to going to bed, the subjects ate pizza, brownies and grape juice to
increase the likelihood of reflux. Treatment with proton pump inhibitor
Nexium reduced the rate of reflux episodes by approximately half, but the
number of non-acid reflux events rose from 6 to 27. Reflux may cause
arousal during sleep, which actually protects the esophagus by increasing
salivation and swallowing. Most reflux events, either acidic or
non-acidic, result in an arousal response within 2 minutes. The fact that
the esophagus is equally responsive to acidic and nonacid reflux indicates
no increased risk of damage to the esophagus. Chest, February 2007.
Proton Pump Inhibitors
and Risk of Cancer
Does the use of proton pump inhibitor drugs that reduce stomach
acid, or the use of H2 blockers increase the risk of cancer of the
esophagus or stomach? Common H2 blockers are ranitidine (Zantac) and
cimetidine (Tagamet); and a common proton pump inhibitor is omeprazole (Prilosec).
Dr. Mats Lindblad and colleagues at the Karolinska Institute in Stockholm
evaluated 7 years of patient data entered into the UK general practice
database. The team identified 287 patients with esophageal cancer and 522
with stomach cancer. These subjects were compared with 10,000 randomly
selected subjects without cancer. The authors found some conditions for
which acid-suppressing drugs are used, such as acid reflux disease, hiatal
hernia and Barrett's esophagus, were associated with an increased risk of
stomach and esophagus cancer. However, no apparent cancer risk was seen
with other conditions, including peptic ulcer, gastritis, and indigestion.
They found no evidence that the proton pump inhibitor drugs themselves
increased the risk. However, Dr. Kenneth E.L. McColl, of the Western
Infirmary, Glasgow, UK says "a major weakness in the study is the
relatively short duration of acid suppressive therapy examined. The
development of cancer in humans is a slow process. The period in question
is really too short to identify or exclude any direct effect between acid
suppressive medication and stomach or esophageal cancers." Gut, November
2006.
Dr. Sahelian says: I agree with Dr. McColl. It would take at least
a 10 to 20 year longitudinal study to determine whether proton pump
inhibitor drugs reduce or increase the risk for cancer and other health
conditions.
Intravenous Proton Pump Inhibitor Drugs
Intravenous administration of a proton pump inhibitor (PPI) is a faster way to achieve gastric acid suppression than oral administration of the same agent. Peak suppression after IV administration occurs within hours, compared with several days later after oral administration. Thus the IV route of administration offers a faster onset of gastric suppression, achievement of intragastric pH closer to neutrality, and better bioavailability. The proton pump inhibitors that have IV formulations in the United States (esomeprazole, lansoprazole, and pantoprazole) are approved for different indications.
Randomised controlled
trials evaluating the clinical effect of proton pump inhibitors (PPIs) in
peptic ulcer (PU) bleeding have yielded conflicting results. PPI treatment
in PU bleeding reduces rebleeding and surgery compared with placebo or
H(2)RA, but there is no evidence of an overall effect on all-cause
mortality.
At equivalent
doses, oral and intravenous (IV) PPIs produce comparable acid suppression;
thus there are very few clinical indications for IV PPI therapy. IV PPIs
are an appropriate substitute for oral PPIs, at an equivalent dose, for
patients with, for example, gastroesophageal reflux disease, peptic
ulceration, or Zollinger-Ellison syndrome, who cannot take oral
medication.
Proton pump inhibitor Research
Proton pump inhibitor therapy is a risk factor for Clostridium difficile
-associated diarrhoea.
Aliment Pharmacol Ther. 2006 Aug 15;24(4):613-9. Department of Adult
Medicine, Royal Gwent Hospital, Newport, South Wales, UK.
Inhibition of gastric acid removes a defence against ingested bacteria and
spores, increasing the risk of some forms of gastroenteritis. Previous
studies investigating a possible link between acid suppression therapy and
Clostridium difficile -associated diarrhoea have reported conflicting
results. Conclusion: The risk of C. difficile-associated diarrhea in
hospitalized patients receiving antibiotics may be compounded by exposure
to proton pump inhibitor therapy.
Proton pump inhibitor
medication questions
Q. Are there any herbs that work the same way as PPIs?
A. I am not aware of specific research with herbs that have found
them to work the same way as a proton pump inhibitor. However, certain
herbs have begun to be evaluated in ulcer healing, such as
prickly pear or cactus
pear. Research is still quite early with herbs. See the ulcer link at the
top of the page.
Q. Is it okay to take alpha
lipoic acid or
resveratrol with
a proton pump inhibitor drug?
A. I have not seen studies regarding this combination, but it would
seem that taking 50 mg or less of lipoic acid a few times a week should be
fine.
Q. Q. I take a Proton Pump Inhibitor
prescription medication every day for gastro esophageal reflux disease.
Are there any natural sex booster supplements that you would recommend
someone taking a proton pump inhibitor should avoid?
A. We have not seen any studies that have looked into the
combination of proton pump inhibitors and natural aphrodisiac herbs or
supplements. As a general rule, small amounts or dosages, such as half a
capsule, of the sex herbs should be safe in most people, but have approval
from your doctor.
Q. I am going off of Prilosec and Prevacid. I have
taken them off and on (not at the same time, of course,) over several
years now. I have terrible diarrhea. I cannot leave the house for an hour
after eating. So I stopped taking Prilosec about a week ago. I feel
better, but wonder if I should have just quit taking it abruptly. Any
danger that you know of in that?
A. We are not aware of any withdrawal symptoms from stopping
Prilosec or Prevacid proton pump inhibitors but much depends on the
condition of a person's stomach and intestines and overall health
condition. The decision to stop these proton pump inhibitors depends on a
number of factors that you and your doctor would need to discuss.
Q. Q. Big fan of your vitamins and input on
herbal supplements. I have a 13 year old son that was just diagnosed with
gastritis and acid reflux. He has been put on proton pump inhibitor
Prilosec 20mg x3 daily and Carafate 10ml x3 daily. Are there any
supplements that could heal and provide relief?
A. Perhaps his doctor can read this page, the page on gerd diet,
along with the page on ulcer.
Q. At the age of 19 my son was diagnosed with
hairy cell leukemia. It was treated with Kemo new drug klydrobin (might be
spelled wrong). when he was 15 or so he was put on Protonix for acid
reflex. He became constipated at the time he was 19 and was diagnosed with
leukemia after all was tested through bone marrow biopsy. Today he has to
have another biopsy done WBC is under 2000. But my reason for this email
is to find out if acid drugs might have connection between constipation
and his disease. I had just found out that he is now taking Prilosec.
Bottom line 2 acid drugs second time for low blood count. I am not sure
were to go with this i am looking for any answers. no help from
local doctor.