Proton Pump Inhibitors: Are They Safe for Long Term Use?
Proton Pump Inhibitors or PPIs have become the front-line treatment for mild to moderate acid reflux, also known as gastroesophageal reflux disease or GERD. Virtually every patient that has not seen improvement with antacid such as TUMS has moved on to PPIs which are readily available, over the counter, and are relatively inexpensive. These highly marketed medicines are the next step in GERD treatment and work by suppressing acid in the stomach. In other words, the reflux does not go away, but rather the contents that are refluxing are no longer as acidic.
PPIs are recommended for use for no longer than six weeks, but unfortunately millions of patients suffering from GERD have taken them for years and even decades. While they may seem relatively benign – after all they are sold over the counter – there are some serious potential side effects associated with long-term PPI use. These may include:
- Potential for deficiencies of important nutrients including calcium and magnesium
- C diff infection as a result of the reduced acidity in the stomach and intestine
- Aspiration pneumonia as a result of stomach contents continuing to reflux into the esophagus and throat
- Osteoporosis, or compromised bone density that may result in fractures
- Vitamin B 12 deficiency
- Acute kidney disease and even long-term kidney failure
So, it is quite clear that long-term use of PPIs is not ideal even if they are an easy, albeit temporary, solution.
What Are Our Options?
Of course, the prevention of acid refluxing into the esophagus is our number one goal. The front line of prevention includes improving diet and exercise habits to lose weight, thus relieving some abdominal pressure that may be pushing acid contents up into the throat. Eating more healthily and exercising may also improve the gut microbiome which has positive metabolic effects throughout the gastro-intestinal system.
Of course, for some, the Lower Esophageal Sphincter or LES may have weakened to a degree that even lifestyle change is not sufficient to prevent reflux. For those patients, a bariatric surgical procedure such as a gastric bypass along with repairing a hiatal hernia, if present, may be an excellent option, especially if the patient is suffering from other obesity related diseases including diabetes, high blood pressure, high cholesterol, sleep apnea and more.
Of course, some patients have had bariatric surgery and continue to reflux (typically this occurs in gastric sleeve and band patients). Other patients may not be candidates for bariatric surgery and experience acid reflux anyway. Any of these patients may benefit from one of two very impressive procedures. The first is a minimally invasive procedure known as a fundoplication which wraps the upper part of the stomach around the lower part of the esophagus to add pressure and stop reflux. The second is a medical device known as the LINX reflux management system – essentially a bracelet made of titanium beads that opens and closes to accommodate food but puts enough pressure on the lower esophageal sphincter that the contents of the stomach cannot reflux back into the esophagus.
Of course, the first step in any new treatment protocols to speak to a qualified physician such as Dr. Tsuda or Dr. Ryan here at VIPSurg. We will work together with your primary care physician to implement a plan for improving or eliminating your chronic acid reflux or GERD.