- Using medicines called PPIs for chronic acidity-related problems is helpful and advisable.
- PPIs don’t help in short-term acidity bouts.
- Overusing them for recurrent acidity issues can lead to serious problems such as kidney and liver damage, heart disease, infections, memory loss, depression, bone fractures, some tumours, and poor nutrient absorption.
Every day, our stomach secretes about two litres of gastric juice, which has stomach acid that plays three important roles:
- Releasing nutrients from food for better absorption;
- Activating enzymes that break food proteins into smaller bits for digestion; and
- Killing pathogens in the food.
- Excessive production of stomach acid can cause ulcers in the digestive tract.
- If the gastric juice comes back into the food pipe (oesophagus), it is called acid reflux.
- Acid reflux causes a burning sensation in the chest, which is called acidity (heartburn).
- Over the long term, repeated spurts of acid reflux damage the oesophagus causing gastroesophageal reflux disease (GERD).
What Are Proton-Pump Inhibitors?
- The most prescribed medicines for acidity (heartburn) today are Proton Pump Inhibitors (PPIs).
- PPIs block an enzyme in the stomach walls that produces stomach acid.
- Lower acid levels reduce acidity symptoms. They also help heal stomach ulcers, GERD, and other disorders related to stomach acid.
- Commonly used PPIs are Omeprazole, Lansoprazole, Esomeprazole, Rabeprazole, and Pantoprazole.
- Due to their excellent results in acidity, PPI usage has exploded worldwide.
Problems with Proton-Pump Inhibitors
There will be three types of problems with PPIs:
- Side effects include abdominal pain, constipation, diarrhoea, flatulence, vomiting, and headache. However, the benefits outweigh the negatives in the case of PPIs.
- Low acid secretion can hamper all three roles of stomach acid. Less acid:
- Reduces nutrient absorption;
- Prevents proper digestion of proteins; and
- Increases the risk of digestive system infections.
- Long-term adverse effects of PPIs are slowly being found. They are: Damage to the kidneys and liver, heart disease, infections in the lungs and digestive system, memory loss, depression, bone fractures, some tumours, and poor nutrient absorption. The research is still evolving and there is considerable debate about the additional risk versus the benefits.
While the problems of side effects and interactions with other medicines exist with all types of medications, PPIs face an additional behavioural issue: Overuse.
Overuse Problems with PPIs
Many of the PPIs are available as Over-The-Counter (OTC) medicines. So they do not need a doctor’s prescription in most parts of the world, including the USA.
In countries like India, people have a habit of self-prescription. In fact, many friendly neighbourhood experts suggest some medicine to their friends or family members because it helped them.
It is often observed that a doctor had prescribed a PPI for someone’s acidity problem, and ten years later, the person is still swallowing the same medicine every time he gets an acidity attack, without checking with a doctor. PPIs were not developed with this abuse in mind.
I have anecdotally heard from many doctors in India that their patients swallow PPIs like ‘peanuts’ every day for years altogether. Such patients demonstrate dementia symptoms, which are corroborated by many, though not all, studies. Beware!
Here is what you should know about using PPIs:
- Chronic or severe acidity problems: Use PPIs. However, once the problem is solved, stop taking them.
- Mild acidity bouts: Take simple antacids for short-term use. PPIs will not help, as they take a few days to ramp up their effect on acid secretion.
- Recurrent acidity problems: Lifestyle changes are far better.
To Read More
- MedicineNet: Proton Pump Inhibitors
- Harvard Medical School: Proton-pump inhibitors: What you need to know
- On this Website: Acidity (heartburn): do’s and don’ts
- Drugwatch: Proton Pump Inhibitor (PPI) Side Effects
- Cureus.com: Adverse Effects Associated with Proton Pump Inhibitor Use
- BMC Medicine: Regular proton pump inhibitor use and incident dementia: population-based cohort study
- Therapeutic Advances in Drug Safety: The risks of long-term use of proton pump inhibitors: a critical review
- Nature: Proton pump inhibitors and the risk of Alzheimer’s disease and non-Alzheimer’s dementias
- JAMA Network: Association of Proton Pump Inhibitors With Risk of Dementia
- TouchReviews in Neurology: Proton Pump Inhibitor Use and Risk of Dementia in Older Adults: A Systematic Review
First published on: 2nd May 2016
Image Credit: Pixabay on Pexels
Last Edited On: 29th May 2023