More than 15 million Americans take prescription heartburn drugs called proton pump inhibitors (PPI) and popular over-the-counter versions like Nexium, Prilosec, and Prevacid. Recently, however, PPIs have come under scrutiny for possible risks associated with long-term use.
PPIs treat the symptoms of heartburn caused by gastroesophageal reflux disease (GERD) by blocking the stomachs ability to produce too much acid. GERD occurs when your stomachs contents back up into the esophagus, the muscular tube that carries food from your mouth to your stomach. When the lower esophageal sphincter the muscular ring that separates the esophagus from your stomach becomes weak and relaxes when it shouldn't, it can wreak all kinds of havoc. And, while this may happen occasionally for some, for others its a chronic condition that requires medication.
Its important to treat GERD because too much stomach acid in the esophagus can result in inflammation, acid scarring and strictures that can cause the lower end of your esophagus to narrow, making it difficult to swallow. It also may lead to a condition called Barrett's esophagus, where the cells of the tissue lining the esophagus changes abnormally and can lead to cancer.
But stomach acid also plays an important role in breaking down food and absorbing nutrients, and kills microbes and bacteria. Long-term use of PPIs may disrupt those functions, leaving people vulnerable to nutritional deficiencies and infections.
Recently, German researchers found an association between regularly taking PPIs and an increased risk of dementia in patients 75 or older. The study found only an association, however, and not a cause-and-effect link. A similar observational study suggested that people taking PPIs long term had a slightly heightened risk of heart attack, but also did not prove cause and effect.
Are these studies cause for alarm? It is important to understand that the associations found in the studies could be caused by other patient factors.
What is needed are randomized controlled studies to establish whether there is a cause-and-effect link. These observational studies are concerned with long-term PPI use. Short-term use is very safe.
What should patients who have been taking PPIs long-term do? Do not stop taking your PPI before talking to your doctor.
There are potential alternatives to long-term PPI use that can control GERD, including dietary changes and cutting out foods that cause heartburn, losing weight, surgery or switching to an acid-reducing H-2 blocker medication like Tagamet HB 200or Pepcid. The key is to discuss all options with your doctor to reach the best treatment plan for you.