Proton-pump inhibitors, or PPIs, are medications available either by prescription or over the counter to treat heartburn and acid reflux. These include the well-known drugs Prilosec, Prevacid, and Nexium.
“If you suffer from heartburn, the advertising for some products make them seem like a foolproof solution … But PPIs have drawbacks that make them a poor choice for most heartburn sufferers,” says Consumer Reports in a recent article titled “When to Consider PPI Drugs for Heartburn.”
Consumer Reports says that those diagnosed with gastroesophageal reflux disease (GERD), which occurs when acid from the stomach repeatedly flows up into the esophagus, whose doctors prescribe PPIs for treatment, could find relief from this class of drug. But, the report continues, “up to 70 percent of people who take a PPI might not need such potent acid reducer and could get just as much – or more – relief from a safer heartburn remedy.”
The article points to the fact that PPIs have been linked to increased risk of kidney disease and many other serious side effects. The report notes that the American Gastroenterological Association has acknowledged the risks linked to long-term use and recommends PPI users take the drug for the shortest time necessary to address symptoms.
A study published this April compared PPIs to other heartburn drugs and H2 blockers (drugs in this class include Pepcid AC and Zantac). The research looked at the treatment of nearly 200,000 patients for more than five years and found approximately 20 percent higher risk of kidney disease in PPI users.
The study authors presented had several possible mechanisms to explain this risk, one being that the drugs interfere with the body’s ability to absorb magnesium. Low magnesium levels are associated with increased risk of kidney disease.
Because PPIs reduce stomach acid, they interfere with the body’s ability to absorb many different minerals, not only magnesium, but also iron, vitamin B12, and calcium, which has led the FDA to warn that taking prescribed PPIs at higher doses and for longer periods of time than the over-the-counter 14-day course of treatment up to three times a year may increase risk of osteoporosis or risk for bone fracture. These are just a few of the many “worrisome risks” of PPIs Consumer Reports lists.
The article notes that the drugs are not the best choice of heartburn relief for those suffering from occasional heartburn because they are intended to be taken daily and don’t provide immediate relief. Also, after long-term use, PPIs are known to have a “rebound effect” where there is an overproduction of stomach acid.
“People can wind up on PPIs indefinitely – even if they don’t need them – because they start to suffer rebound symptoms every time they try to stop,” says M. Michael Wolfe, M.D., chair of the department of medicine at Case Western Reserve University in Cleveland, Ohio.
Journal of the American Society of Nephrology
U.S. Food and Drug Administration