Are PPIs the Right Solution for Heartburn?
As a physician, I was very skeptical when pharmaceutical manufacturers began to promote prescription medications – which can have very serious side effects – on TV. As an expert on gastroesophageal reflux disease (GERD), I am shocked at the frequency of the Proton Pump Inhibitor (PPIs) commercials – even Larry the Cable Guy is now an expert on how to manage your heartburn.
What I, and most GERD experts believe, is that in order to make an informed decision regarding taking PPIs, or any drug for that matter, one must understand exactly what the drug does, why it is prescribed, potential side effects, and other options for treatment. At $14 billion in US sales annually and growing, it is fair to say that PPIs are used indiscriminately in the United States without the above criteria being satisfied.
PPIs are effective in decreasing the production of acid in the stomach, making its contents less irritating when they reflux into the esophagus. However, they do nothing to decrease the frequency or volume of your reflux. In effect, they make you feel better without addressing the disease itself. That comes at a price:
- Once you begin, PPIs are likely to be required for life.
- PPIs have immediate possible side effects of headache, diarrhea, and abdominal pain.
- Long-term side effects include increased risk for hip fracture; a serious colon infection called C. difficile colitis; pneumonia; a low magnesium level which can lead to heart rhythm problems; and interaction with other drugs.
- Almost 40% of people on PPIs continue to have symptoms.
- Over 30% of PPI users do not have reflux disease.
Given those issues, what else can you do? First, confirm that you have reflux disease. Diagnosing via symptoms or reduced improvement on PPIs is not a good means of diagnosing GERD. See a physician who can perform the necessary diagnostics to validate a GERD diagnosis. If you are found to have reflux disease, there are many other things you can do to reduce your GERD symptoms:
Lifestyle Changes can reduce or eliminate the need for such potent medications.
Diet: Knowing and avoiding your “trigger” foods can result in significant symptoms reduction.
BMI: Those extra pounds put pressure on your diaphragm causing an increase in GERD symptoms.
Medications: If you need medication to control your symptoms, there are several other prescription drug categories that are available with fewer side effects, such as H2 blockers (Zantac, Tagamet), as well as antacids like Tums and Mylanta. It is also important to point out that if any of these medications are needed, they should not be taken daily but only to control symptoms.
Finally, the most important thing you can do is to learn more about your heartburn. Reflux disease is a long-term chronic condition that can progress, leading to many complications including Barrett’s esophagus and adenocarcinoma (esophageal cancer). I recommend that our patients with reflux disease visit www.refluxmd.com, an internet healthcare community dedicated to GERD. Educate yourself, know all your treatment options, build your support team (including a GERD expert), and build your plan to symptom relief and good health.
Dr. Johnson is a board-certified general surgeon with Premier Surgical Associates in Palm Springs and can be reached at (760) 424.8224.