Proton-Pump Inhibitors and Acid Reflux

By Patricia Raymond, Michelle Beaver

Proton-pump inhibitors (PPIs) are commonly prescribed for patients with acid reflux. PPIs help prevent acid reflux outbreaks instead of treating symptoms that have already manifested. PPIs are the most common medication prescribed to GERD patients. In fact, they’re among the most widely prescribed medications in the world, with 119 million U.S. prescriptions written in 2009 alone.

This type of drug comes in both prescription and over-the-counter forms. The main difference between the over-the-counter and prescription PPIs is the dosage of the drug.

If you take an over-the-counter variety, be sure to follow the usage instructions carefully and do not take them for more than two weeks unless you have permission from your doctor.

PPIs are often prescribed in conjunction with antacids. PPIs help prevent and reduce future outbreaks of acid reflux, while the antacids provide immediate relief for heartburn and reflux flare-ups.

How PPIs work

PPIs reduce the production of stomach acid. Instead of shutting down histamine receptors in acid-producing stomach cells like H2 receptor antagonists, PPIs disable the pumps that push acid into the stomach.

This raises the stomach’s pH level, making the stomach’s contents less acidic. By reducing the acidity of the stomach, there’s less acid available to shoot into the esophagus. When you do experience reflux, your stomach’s contents will do significantly less damage to your esophagus.

This type of drug reduces stomach acid production by blocking a particular enzyme in the wall of the stomach that is responsible for acid production. PPIs, just like the name implies, block proton pumps in your stomach. These pumps function by taking non-acidic potassium ions out of the stomach and replacing them with an acidic hydrogen ion.

By pumping these hydrogen ions into the stomach, the stomach’s contents become more and more acidic with hydrogen chloride, a powerful acid. PPIs block this function, reducing the amount of acidic hydrogen ions pumped into the stomach, and lowering the overall acid balance or pH.

What PPIs are good for

PPIs are great for preventing and reducing the severity of future acid reflux outbreaks. They’re very effective tools for lowering your stomach’s acid level and regulating your stomach’s pH. Even when you do have a bout of reflux, PPIs can help minimize the severity of the associated symptoms. This also means that there will be less damage done to your esophagus over the long term.

That’s why taking an H2 receptor antagonist or PPI can have an impact on your overall risk of developing more serious complications associated with reflux, such as esophageal stricture, Barrett’s esophagus, or esophageal cancer.

Although PPIs take longer to work than antacids or H2 receptor antagonists, they generally provide longer-lasting protection. Most of the PPIs currently on the market are taken once every 24 hours. Occasionally your doctor will need to push up the dose to control your heartburn symptoms.

If you have a cough, hoarseness, throat clearing, or asthma, your doctor may prescribe twice-daily PPIs from the get-go, and continue them for three months to see if you have any improvement in your symptoms.

Because they help reduce the acidity level inside the stomach, PPIs are also very helpful in reducing your risk of developing stomach and esophageal ulcers (shallow divots in the lining of the stomach or esophagus that can lead to discomfort and further health complications, but rarely requiring surgery). PPIs can be used to heal esophagitis.

What PPIs are not so good for

PPIs take some time to begin working, but they’re slower than H2s. This means they aren’t ideal for treating immediate reflux flare-ups or popping before a hedonistic night on the town. They also don’t treat some specific symptoms of reflux complications such as the feeling of food sticking in your throat from a stricture or narrowing of the esophagus.

PPIs can reduce the amount of acid that your esophagus, larynx, or teeth are exposed to, but they won’t directly heal any previous damage. They can still be helpful, however, in that they reduce the frequency and severity of your reflux flare-ups.

This gives your body more time to heal between outbreaks, and minimizes the damage done by any particular reflux outbreak. The esophagus and larynx may heal on their own when no longer exposed to acid.

PPIs can be very helpful in treating GERD over the long run, but they’re not the perfect cure. Just because your symptoms are reduced, doesn’t mean you can eat or drink whatever you want. One of the issues associated with PPIs is that patients who find relief may not make the necessary lifestyle changes to reduce the risks associated with acid reflux.

If you take PPIs, be careful to strictly follow the usage instructions. Taken properly, PPIs will block most but not all acid from the stomach, and you can retain a healthy balance.

Potential side effects

Recent research has suggested that there are several possible side effects associated with PPIs. Some of these are the result of overuse and misuse, but there are also some serious risks associated with proper long-term use. It’s fairly common for PPIs to be used to treat GERD patients. Because GERD is a chronic condition, you may end up being on some sort of medicine for much of your life.

Due to the potential side effects and risks associated with long-term use of PPIs, it’s important that your doctor give you not only detailed instructions on use and dosage, but also clear recommendations for the length of treatment. Make annual follow-up appointments with your doctor to ensure that you’re not developing complications. There are a few main side effects most commonly associated with PPIs:

  • Rebound acid hyper secretion risk

  • Osteoporosis and bone fractures

  • Infections