Proton Pump Inhibitors (PPIs) such as Nexium, Prevacid, and Protonix, are some of the most widely prescribed drugs in the U.S. They are typically given to patients who complain of heartburn or reflux (GERD), who are then kept on the medication indefinitely. In fact, it’s not uncommon for many of the patients I see to think of being on this medication almost as an afterthought, because it’s so common in our culture. What they may not realize is that long-term use of these medications can lead to long-term complications, and may be doing more harm than good! When first approved by the FDA, the suggested use of PPIs was for 4-6 weeks, mainly for treating serious gastrointestinal issues, like ulcers and Barrett’s esophagus.
However, because these drugs are more effective for relieving symptoms of GERD than other medications, they became the treatment of choice for general complaints of “indigestion”. While some doctors may be closely monitoring these medications, and weaning their patients appropriately, it’s more common for patients to be on PPIs for years without anyone questioning whether they still need them or not. This is a serious problem, as a number of long-term risks have been associated with PPIs. In 2012, the FDA issued warnings about Clostridium difficile-related diarrhea, which can be extremely challenging to treat, especially in the elderly population. In 2011, the FDA warned doctors about the risk of magnesium deficiency with the use of PPIs, which can potentially lead to arrhythmia and seizures. They even recommended that doctors screen their patients for low magnesium before prescribing PPIs. In reality, how many doctors are actually following this protocol? This doesn’t even include other documented risks of long-term PPI use, such as iron-deficiency anemia, vitamin B12 deficiency, increased fracture risk, and increased risk of pneumonia.
The guidelines established by the American Gastroenterological Association suggest that GERD or dsypepsia without any serious complications use PPIs for only 4-6 weeks, followed by the use of less potent acid blockers (ranitidine) as needed. This greatly reduces the risk of long-term complications associated with these medications. In my experience, there is typically an underlying cause for symptoms of GERD, whether it’s diet, stress, and/or medication side-effects. Fortunately, it’s not impossible for you to wean off PPIs, it just takes patience to gradually taper the dosage, while simultaneously addressing underlying causes. There are a number of natural agents, such as DGL, aloe vera, and D-limonene, that can help to heal irritated gastroesophageal tissue to make the transition of discontinuing the medication more tolerable. Plus, these agents can be used for ongoing symptom management without having the harmful side-effects of PPIs.
Believe me, I’ve seen a number of patients who never thought in a million years that they would be able to stop their PPI medication, in fear of the reflux symptoms coming back with a vengeance. But, with the proper guidance and attention to detail, it can be done!
