Sunday, October 18, 2009

Good News for Proton Pump Inhibitors (PPI)


Proton Pump Inhibitor drugs (PPIs) have been used since the 1980s to reduce gastric acid secretion and to treat ulcers and reflux. They are now among the most widely prescribed drugs world wide and Prilosec and others can be obtained over- the- counter. Any time drugs are used long term, we should be re-evaluating their safety. The good news for PPIs, is that they are safe for chronic use.

PPIs do their work on the parietal cells of the stomach. They bind at the "proton pump" and prevent secretion of acid into the stomach. The effect is prolonged (24-48 hours) and the drug is cleared by the liver with very little effect on the kidneys.

The side effects are few so these medications (Prilosec, Aciphex, Prevacid, Protonics) are often prescribed to hospitalized patients and for patients with GERD, gastritis and ulcers. Patients take these medications for years and there have been numerous studies that looked at potential long-term effects of PPI use.

The studies have shown that PPIs are highly effective drugs and they have revolutionized the management of acid-related disorders during the last 2 decades. When was the last time you heard of someone getting surgery for "ulcers"? That was a common treatment just 30 years ago.

Studies that looked at PPIs and their effect on Vit B12 absorption, iron loss, colon cancer, gastric cancer and calcium deficiency found no definite link. There may be an association in hospitalized patients who are on PPIs and the incidence of Clostridium difficile infection. No association was seen in non-hospitalized patients.

As with all medications, PPIs should be used for appropriate indications only as long as needed. If you or a friend have been taking PPIs for a long time, you may wish to talk with your doctor about a "drug holiday" to see if it is still needed. I review chronic medications with my patients at least every year with the goal of eliminating any that are not absolutely needed.

13 comments:

Raymond Bouchayer said...

Is Zantac 150 the same ? it seems to do the job for me , sometime I take two a day and sometime none . I thought that those meds were all the same .

Toni Brayer MD said...

Raymond: Zantac is not the same. It also works for reflux but it is not a PPI and does not work the same.

KM said...

Thanks for this excellent info. I will pass it along to someone I know who was on Protonix for years and switched to Prilosec since it is the same and now over the counter.

Molly's Mom said...

No, Zantac is not the same; neither is Pepcid. I wish we'd known exactly what good PPIs were a number of years ago. My dad had esophageal cancer (non-drinker, non-smoker) but had acid reflux for many years that he was taking OTC Pepcid for. (He was on a prescription med but then went off with his doc's OK when Pepcid seemed to do the trick). We'd had no idea he'd even had Barrett's Esophagus until he started taking a blood thinner and had a GI bleed. Apparently he'd had it a while b/c it developed into cancer.
Dr. Toni, would you advise someone who's had chronic acid reflux to get scoped, just to make sure there's no Barrett's? If we'd only known earlier, we might have been able to take care of it before it got to Stage IV.

Toni Brayer MD said...

Molly's Mom: Sorry for your terrible experience and you are so correct about chronic reflux. An upper endoscopy is indicated to look at the cells of the esophagus. Chronic acid reflux can alter the cells and Barrett's esophagus means those cells are abnormal and close surveillance is needed.

Thanks for sharing your story.

Anonymous said...

Cool, any recent major studies backing this up?

elliot said...

Steven DeMeester is a foregut surgeon at USC, and one of the leading world experts in acid reflux. I'm a GI fellow in southern california where he came and spoke at our grand rounds regarding esophageal adenocarcinoma. He showed some pretty convincing evidence that the liberal use of PPI's could be linked to the exponential rise in esophageal adenoCA, possibly related to bile reflux as opposed to acid reflux. Nothing's been published yet, but he's working on some epidemiology data and I'm sure it'll be published soon.

Also, as I'm sure you are aware, several studies have now been published looking at PPI use and Plavix. Whenever I start my patients on a PPI, I always let them know of these two findings. Anyways, thanks for your blogs, and keep up the good work!

Toni Brayer MD said...

Anon: The information from for the blog came from a meta-analysis of PPIs reported in American Journal of Medicine, Sept, 2009.

elliot: Thank you for the up to date information on this subject. I have no doubt that future studies will be done and new data will come out so I look forward to Dr. DeMeester's report.

Lynne Kossey said...

If I am taking an H2 blocker for peptic ulcers, should I also be taking the proton pump inhibitor Prilosec along with the H2 blocker?

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