Proton Pump Inhibitors

Treatment for gastroesophageal reflux disease (GERD) usually consists of three stages. The first two stages include taking medications and making diet and lifestyle changes. The third stage is surgery. Surgery is generally used only as a last resort in very severe cases of GERD that involve complications.

Most people will benefit from first-stage treatments by adjusting how, when, and what they eat. However, diet and lifestyle adjustments alone may not be effective for some. In theses cases, doctors may recommend using medications that slow or stop acid production in the stomach.

Proton pump inhibitors (PPIs) are one type of medication that can be used to reduce stomach acid and relieve GERD symptoms. Other medications that can treat excess stomach acid include H2 receptor blockers, such as famotidine (Pepcid AC) and cimetidine (Tagamet). However, PPIs are usually more effective than H2 receptor blockers and can ease symptoms in the majority of people who have GERD.

How Do Proton Pump Inhibitors Work?

PPIs work by blocking and reducing the production of stomach acid. This gives any damaged esophageal tissue time to heal. PPIs also help prevent heartburn, the burning sensation that often accompanies GERD. PPIs are one of the most powerful medications for relieving GERD symptoms because even a small amount of acid can cause significant symptoms.

PPIs help to decrease stomach acid over a four to 12-week period. This amount of time allows for proper healing of the esophageal tissue. It may take longer for a PPI to ease your symptoms than an H2 receptor blocker, which usually starts reducing stomach acid within one hour. However, symptom relief from PPIs will generally last longer. So PPI medications tend to be most appropriate for those with GERD.

Are There Different Types of Proton Pump Inhibitors?

PPIs are available both over-the-counter and by prescription. Over-the-counter PPIs include:

Lansoprazole and omeprazole are also available by prescription, as are the following PPIs:

Another prescription drug known as Vimovo is also available for treating GERD. It contains a combination of esomeprazole and naproxen.

Prescription-strength and over-the-counter PPIs seem to work equally well in preventing GERD symptoms.

Talk to your doctor if GERD symptoms don’t improve with over-the-counter or prescription PPIs within a few weeks. You could possibly have a Helicobacter pylori (H. pylori) bacterial infection. This type of infection requires more complex treatment. However, the infection doesn’t always cause symptoms. When symptoms do develop, they’re very similar to GERD symptoms. This makes it hard to distinguish between the two conditions. Symptoms of an H. pylori infection may include:

  • nausea
  • frequent burping
  • loss of appetite
  • bloating

If your doctor suspects you have an H. pylori infection, they will run various tests to confirm the diagnosis. Then they will determine an effective treatment plan.

What Are the Risks of Using Proton Pump Inhibitors?

PPIs have traditionally been considered to be safe and well-tolerated medications. However, research now suggests that certain risks may be involved with long-term use of these drugs.

A recent study found that people who use PPIs long-term have less diversity in their gut bacteria. This lack of diversity puts them at an increased risk for infections, bone fractures, and vitamin and mineral deficiencies. Your gut contains trillions of bacteria. While some of these bacteria are “bad,” most of them are harmless and help in everything from digestion to mood stabilization. PPIs may disrupt the balance of bacteria over time, causing the “bad” bacteria to overtake the “good” bacteria. This can result in illness.

Additionally, the U.S. Food and Drug Administration (FDA) issued a public safety announcement in 2011 that stated long-term use of prescription PPIs might be associated with low magnesium levels. This can result in serious health problems, including muscle spasms, irregular heartbeat, and convulsions. In about 25 percent of the cases that the FDA reviewed, magnesium supplementation alone didn’t improve low serum magnesium levels. As a result, PPIs had to be discontinued.

Yet the FDA emphasizes that there’s little risk of developing low magnesium levels when using over-the-counter PPIs as directed. Unlike prescription PPIs, over-the-counter versions are sold at lower doses. They are also generally intended for a two-week course of treatment no more than three times a year.

Despite the potential side effects, PPIs are usually a very effective treatment for GERD. You and your doctor can discuss the potential risks and determine whether PPIs are the best option for you.

Next Steps

When you stop taking PPIs, you may experience an increase in acid production. This increase can last for several months. Your doctor may gradually wean you off these drugs to help prevent this from happening. They may also recommend taking the following steps to reduce your discomfort from any GERD symptoms:  

  • eating smaller portions
  • consuming less fat
  • avoiding laying down for at least two hours after eating
  • avoiding snacks before bedtime
  • wearing loose clothing
  • elevating the head of the bed about six inches
  • avoiding alcohol, tobacco, and foods that trigger symptoms

Make sure to consult with your doctor before you stop taking any prescribed medications.