Proton pump inhibitors (PPIs): Over the Counter Does Not Equal Safe Long Term

Heartburn is a very common problem. Most of us have felt it at one time or another, and some of use suffer with it daily. Heartburn is a symptom that is often attributed to too much stomach acid and in  the conventional medical system, doctors often use acid blocking medications such as proton pump inhibitors as treatment. Since these medications are available over the counter, you may also self prescribe them. PPIs or proton pump inhibitors like omeprazole and pantoprazole are some of the most commonly prescribed medications on the market. In the short term, these medications are helpful in the treatment of peptic ulcer disease, along with antibiotics for peptic ulcer associated H. pylori infections, prevention and treatment of NSAID induced peptic ulcer disease, gastrinoma and other conditions of acid hypersecretion1.

Treating heartburn with these medications however is (most of the time) using the band aid approach. It is not addressing the true cause of the symptom. Not addressing the cause leads to the return of symptoms when you attempt to stop the medication, which can lead to long term use. These medications may also enable behaviors like overeating, and may cover up food sensitivities. Research supports the use of PPI medications for short term use (4-8 weeks in most cases) but people commonly end up taking them for years. Long term use of PPIs has been found to increase your risk for micronutrient deficiencies, osteoporosis, increased risk of fractures, GI infections including Clostridium difficile, pneumonia, vitamin B-12 deficiency, and chronic kidney disease. There is also suspicion that they contribute to developing dementia, a theory currently debated by the scientific community2.

Heartburn can be a symptom of food sensitivity, overeating, hiatal hernia, low stomach acid, high stomach acid, cancer, H. pylori infection, asthma and obesity. As a Naturopathic doctor my goal is to identify and treat the root cause of your symptoms. Each of those underlying conditions would be treated differently and treatment tailored specifically to your unique circumstances. I am passionate about gastrointestinal health, I want you to be able to trust your gut!

Sources:

  1. Savarino, V., Dulbecco, P., Bortoli, N. D., Ottonello, A., & Savarino, E. (2017). The appropriate use of proton pump inhibitors (PPIs): Need for a reappraisal. European Journal of Internal Medicine,37, 19-24. doi:10.1016/j.ejim.2016.10.007
  2. Nehra, A. K., Alexander, J. A., Loftus, C. G., & Nehra, V. (2018). Proton Pump Inhibitors: Review of Emerging Concerns. Mayo Clinic Proceedings, 93(2), 240-246. doi:10.1016/j.mayocp.2017.10.022