Proton pump inhibitors (PPIs) represent the primary class of acid-suppressing medications used to treat indigestion, heartburn, peptic ulcer disease, and gastroesophageal reflux disease (GERD).  Other acid-suppressing medications include H2 receptor blockers (such as Zantac and Pepcid AC), but PPIs tend to be significantly more effective than these medicines.  Because of their impressive efficacy, tolerability, and safety profile, PPIs are among the most commonly used medications in the United States and the world.  Many people take over-the-counter PPIs temporarily to ease occasional digestive discomfort, but for people with chronic GERD, Barrett’s esophagus, peptic ulcer disease, gastritis, or other serious conditions, PPIs may become a daily necessity for years.

How Do PPIs Work?

As their name suggests, proton pump inhibitors work by essentially blocking gastric proton pumps (acid-secreting pumps) in the stomach, thus reducing the production of stomach acid.  Because of their mechanism of action, PPIs are significantly more effective than H2 receptor blockers, and they can decrease acid secretion by up to 99%.  Reducing the level of acid in the stomach can aid in the healing of ulcers in the esophagus, stomach, and small intestine and can relieve symptoms of indigestion and heartburn.

Are Some PPIs Better Than Others?

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

  • Lansoprazole (Prevacid)
  • Omeprazole (Prilosec)
  • Esomeprazole (Nexium)

The above medications are also available by prescription, as are the following:

  • Dexlansoprazole (Dexilant, Kapidex)
  • Pantoprazole (Protonix)
  • Rabeprazole (Aciphex)

There is no clear evidence showing that one PPI works better than another.  Some PPIs are more potent than others, and cost does vary significantly between different PPIs.

What Are the Risks of PPI Use?

Generally, PPIs carry few side effects and are believed to be very safe for short- and long-term use.  However, recent research has shined a spotlight on some of the potential risks associated with use of PPI medications.  While side effects and complications are rare, they include low magnesium levels, IBS symptoms (such as gas, bloating, and diarrhea), and an increased risk of developing osteoporosis, bone fractures, intestinal infections (such as C. diff), pneumonia, microscopic colitis, Alzheimer’s disease,  chronic kidney disease, and endothelial cell and heart dysfunction.  Continued research is helping physicians to better understand the full picture and how these emerging worries should be appropriately addressed in patient care.  For many people, the benefits of PPIs significantly outweigh the risks.  If you are concerned about side effects or risks, and if you are considering reducing or stopping your PPI, you should talk with Dr. Treyzon before altering your medication regimen.

Author Natalie Bransky Assistant to Dr. Treyzon

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