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Got heartburn? Avoid these common acid-blocking drugs

The Bottom Line

  • Proton pump inhibitors (PPIs) are widely prescribed for common gastrointestinal issues including heartburn from acid reflux, but many people can safely reduce or stop this medication.
  • Research recommendations are to prescribe PPIs at the lowest dose and for the shortest duration necessary.
  • People taking PPIs should be evaluated regularly to see if the drugs can be stopped.
  • Effective ways to discontinue PPIs include patient education and cutting back on the drugs gradually.

 

Do you suffer from stomach (gastrointestinal) problems causing heartburn? It can be a huge relief to find treatment options that work. Perhaps you keep some over-the-counter tablets, pills or liquids on hand to help. Or maybe, like millions of North Americans, you’ve graduated to a stronger type of prescription drug known as proton pump inhibitors (PPIs).


PPIs work by reducing the amount of acid produced in the stomach. For people with gastric ulcers or gastroesophageal reflux disease (GERD), PPIs’ acid-blocking abilities help ulcers to heal or prevent damage to the esophagus. They do the job, which is why they’ve increasingly been prescribed for more common gastrointestinal issues like heartburn. PPIs – for example, esomprazole (Nexium), omeprazole (Prilosec) and lansoprazole (Prevacid) – are one of the most commonly prescribed types of medication worldwide (1).


But that trend may be over as more health professionals are taking steps to stop the overprescribing of PPIs, which has accounted for billions of dollars in drug costs (2). There has also been a lot of press on the possible harms of PPIs. There is evidence that people taking PPIs may be more likely to get GI infections (3) but other possible harms may turn out not to be true (4).


Nevertheless, Dr. Paul Moayyedi – Director of Gastroenterology at McMaster University – points out that these studies highlight, "You can never be sure a drug is safe and it is important not to take drugs that you don’t really need."


Awareness of the potential harms and overprescribing of PPIs has shifted the focus of research to find safe and effective ways to get people off this type of medication (5).


What the research tells us

Research evidence shows that many people are prescribed PPIs unnecessarily and at too high a dose (5). Awareness and education – giving people the facts about the risks associated with PPIs – is a first step to discontinue the drug. Tapering off (gradually reducing the medication) is recommended as a safe way to do so (5). This can help to avoid the uncomfortable “rebound” acid reflux that can happen when acid blocking drugs are withdrawn too quickly (6).


Used appropriately, PPIs are beneficial in treating certain illnesses. But Health Canada advises they be prescribed at the lowest dose and the shortest duration necessary to treat the condition (7). Dr. Moayyedi  agrees that most patients can safely reduce or stop their PPI medications. "The exception to this are people with a condition called Barrett’s esophagus and some patients that have a previous bleeding gastric or duodenal ulcer (or at high risk of having this)."


What does it mean for people experiencing common – yet still distressing – episodes of heartburn? First, ask your doctor or pharmacist if your heartburn or ulcer medication is a PPI. If so, work together to decide whether or how to taper off this medication.


Safer solutions may include trying a few lifestyle changes (for example, changing your eating and drinking habits or sleep positions) supplemented when needed with over-the-counter antacid pills and tablets if necessary.


Maybe they won’t be as quick a fix, but they do work (8) and what a relief to know you’re not putting yourself at risk of additional health problems.

Featured Resources

  1. Web Resource Rating: Treatment options for GERD
  2. Web Resource Rating: GERD: Treatments and drugs
  3. Web Resource Rating: Peptic ulcer: Treatment

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References

  1. Haastrup P, Paulsen MS, Begtrup LM et al. Rapidly increasing prescribing of proton pump inhibitors in primary care despite interventions: A nationwide observational study. Eur J Gen Pract. 2014; 20(4):290-293. doi:10.3109/13814788.2014.905535.
  2. Forgacs I, Loganayagam A. Overprescribing proton pump inhibitors. BMJ. 2008; 336(7634):2-3. doi: 10.1136/bmj.39406.449456.BE.
  3. Leonard J. Marshall JK. Moayyedi P. Systematic review of the risk of enteric infection in patients taking acid suppression.  American Journal of Gastroenterology 2007; 102: 2047-56.
  4. Moayyedi P, Leontiadis GI.  The risks of PPI therapy.  Nature Reviews of Gastroenterology & Hepatology 2012; 9: 132-9.
  5. Haastrup P, Paulsen MS, Begtrup LM et al. Strategies for discontinuation of proton pump inhibitors: A systematic review.  Fam Pract. 2014; 31(6):625-630. doi: 10.1093/fampra/cmu050.  
  6. Reimer C, Sondergaard B, Hilstead L et al. Proton pump inhibitor therapy induces acid-related symptoms in healthy volunteers after withdrawal of therapy. Gastroenterology. 2009; 137(1):80-87. doi: 10.1053/j.gastro.2009.03.058. 
  7. Health Canada. Summary safety review – Proton Pump Inhibitors – assessing the potential risk of Clostridium difficile infection. [Internet] 2016. [cited March 2017]. Available from http://www.hc-sc.gc.ca/dhp-mps/medeff/reviews-examens/ppi-ipp-eng.php
  8. Tran T, Lowry AM, El-Serag HB. Meta-analysis: The efficacy of over-the-counter gastro-oesophageal reflux disease therapies. Aliment Pharmacol Ther. 2007; 25(2):143-153.

DISCLAIMER: The blogs are provided for informational purposes only. They are not a substitute for advice from your own healthcare professionals.

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