Proton Pump Inhibitors & GERD

Proton pump inhibitors are commonly prescribed to reduce stomach acid and relieve the symptoms of gastroesophageal reflux disease. While these medications have traditionally been viewed as safe by consumers, research increasingly suggests that certain risks may be associated with long-term use. In reality, these drugs are only recommended for short durations and carry risks of abdominal infections, muscle wasting, bone loss, fracture and more if used long term. 

 

What is gastroesophageal reflux disease (GERD)?

Gastroesophageal reflux disease (GERD) is a chronic digestive disorder that is thought to occur when stomach acid flows back into the esophagus causing inflammation and irritation. While that is true the real cause is rarely that the stomach has too much acid. 

The symptoms of acid reflux stems from stomach contents entering the esophagus causing heartburn symptoms such as a burning sensation in your chest after eating. The traditional and intuitive treatment is to reduce the acidity of the stomach so the reflux of food doesn’t burn the esophagus. 

Experiencing reflux occasionally is quite common, however, when the condition persists regularly (for example two to three times per week) over a period of several weeks, this may indicate GERD.

While GERD in itself is not life-threatening, chronic inflammation of the esophagus can lead to more serious complications including:

  • Esophageal ulcers/esophagitis 

Stomach acid can wear away at the lining of the esophagus and create open sores. These ulcers can be painful, bleed, and make swallowing difficult.

  • Strictures

Damage to the lower esophagus from stomach acid can cause scar tissue to form. This narrows the pathway to the stomach and can prevent food from reaching the stomach.

  • Barrett’s esophagus

Damage caused by stomach acid can affect the cells lining the lower esophagus. These changes to the lining of the esophagus are associated with an increased risk of developing esophageal cancer.

There are a number of medications commonly prescribed to control, or relieve, the symptoms of GERD ranging from over-the-counter (OTC) antacids to stronger prescription drugs such as proton pump inhibitors. 

It should be noted, however, that ongoing research into the effectiveness of GERD medications, in particular proton pump inhibitors, shows that prolonged use can in fact have negative effects on your health. They also do not treat the real problem more frequently causing GERD, gut dysfunction. 

What are proton pump inhibitors?

Proton pump inhibitors (PPIs) are a class of medications prescribed for a variety of gastrointestinal disorders including the prevention and treatment of GERD. 

PPIs suppress, or inhibit, the production of acid made by cells in the lining of your stomach. The name ‘proton pump inhibitor’ originates from the effect of PPIs on the hydrogen/potassium adenosine triphosphatase enzyme system, otherwise known as the proton pump. Found in the cells responsible for producing gastric acid, this enzyme is blocked by PPI agents, resulting in a significant reduction in acid secretion.

Some common PPIs include pantoprazole (Protonix), omeprazole (Prilosec), lansoprazole (Prevacid), rabeprazole (Aciphex), and esomeprazole (Nexium). 

At first glance PPI therapy seems to be well tolerated and considered safe. Historically, the use of PPIs in the management of GERD and other diseases has shown great efficacy and low toxicity, producing good results. But at what cost? Like everything in medicine all treatment comes with a trade-off. 

Despite having had a favorable track record in GERD treatment over the past several decades, recent studies have indicated increasing concerns about the potential link between long-term PPI use and a higher risk of serious illness.

The dangers of long-term use with PPIs

PPIs are one of the most frequently prescribed medications in the world. Due to a rise in the number of OTC PPIs, combined with inadequate re-evaluation, maintenance, and discontinuation practices, a large percentage of PPI users are inappropriately continued on the medication. 

Instances of open-ended use of PPIs can lead to negative consequences in the long term. Recent studies have noted that prolonged use of PPIs may increase the risk of:

  • Bone fractures

Concern has grown over the potential association between extended PPI use and fracture risk, based on data from multiple observational studies. A causal link between acid suppression and the body’s ability to absorb calcium has been reported, resulting in decreased bone mineral density. At high doses, the use of PPIs can increase the risk of hip, wrist, and spine fractures. 

  • Hypomagnesemia (low magnesium) 

Studies have reported that chronic use of PPIs can result in hypomagnesemia, or magnesium deficiency. Magnesium is absorbed from the small intestine and is essential in supporting muscle and nerve function. PPIs have been shown to impair the gastrointestinal absorption of magnesium causing levels to decrease dramatically. Low levels of magnesium can lead to serious complications such as seizures and arrhythmias.

  • Vitamin B12 deficiency

Vitamin B12 is crucial for brain function, nerve tissue health, and the production of red blood cells. Gastric acid aids in the absorption of dietary vitamin B12. Acid suppression through the use of PPIs can increase instances of B12 deficiency by decreasing protein digestion in the stomach.

Other potential side effects caused by long-term PPI use include:

  • Chronic kidney disease
  • Dementia
  • Clostridium difficile (bacterium causing severe diarrhea)

Overuse

The same factors that have made PPIs one of the most prescribed gastrointestinal therapies, their efficacy, and overall safety profile, have also contributed to their overuse and even abuse.

As one of the most widely prescribed medications, PPIs also have a high prevalence of being prescribed for poorly defined reasons or instances where the use of PPIs has not shown to be beneficial. 

In recent years, PPIs have become frequently administered to patients who may be experiencing acid reflux symptoms based on observation alone. By employing ‘the PPI test’, a rapid symptom response to the medication is considered indicative of GERD and long-term therapeutic use of PPIs is often the result.

Ongoing self-medication with OTC PPI agents, beyond the prescribed course of therapy, is increasingly prevalent in the treatment of GERD. Unsupervised, it may be very likely that you or someone you know are incorrectly or unnecessarily using PPIs.

Long-term PPI therapy is indicated in certain conditions and all medication recommendations should be discussed with your doctor. 

The real cause of GERD

The reality behind GERD symptoms is that stomach acid is not he culprit. We treat the acid as if it’s bad but it’s not only good, it’s critical to proper gut function. Similar to cholesterol and heart disease stomach acid does result in burning of the esophagus BUT it is guilty by association. 

Stomach acid only causes issues when the gut is dysfunctional. Assuming you have no structural abnormalities, the stomach contents should stay in the stomach. The only reason why it would be pushed upward is because of delayed motility of the gut downstream and inadequate digestive function. 

Ironically this reduced function can sometimes be the result of too little stomach acid slowing down the initial breakdown of food. For many patients the appropriate treatment of GERD is actually providing the stomach MORE acid to do it’s job better. 

Traditional treatment involves suppressing stomach acid, positioning yourself so that the stomach acid must fight gravity to push upward and avoiding foods that provoke symptoms. While avoiding spicy foods may be helpful the rest of this advice avoids the underlying cause of the problem. 

Optimal Gut Function and real GERD management

For more information about the use and dangers of proton pump inhibitors in the treatment of gastroesophageal reflux disease, contact Optimal Human Health today. Learn how we identify the underlying cause of GERD and help people stop using medications that can cause severe disease. 

Our optimization approach to disease prevention and management prioritizes education, nutrition, and lifestyle modification to optimize your health, identify the underlying issues and help you meet your health goals.

Doug Lucas
Author: Doug Lucas

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