When the powerful gastric acid reducing class of drugs known as proton pump inhibitors (PPIs) were introduced to the world of modern medicine, they were used primarily as short term treatment of patients with severe peptic ulcer disease. These “PPIs” were considered wonder drugs—they had an extremely safe profile, few drug interactions and were well tolerated (or so we thought at the time). Once they were made available in pill form, I witnessed firsthand how they blossomed to become one of the most widely prescribed medicines on earth. These potent drugs were no longer reserved for the very ill, but were being prescribed as a prophylactic medicine—given to a healthy patients to prevent complications such as gastritis during a hospital admission or in the outpatient setting for those with even mild reflux (with the hopes of preventing esophageal cancer). As physicians we were blinded by the popularity of these drugs, believing that they could do no harm since they seemed so well tolerated by patients. It was not until my daughter had to take one of these drugs that I began to think about the implications and widespread reach of these drugs on our population as a whole.
Why is stomach acid so bad? It can be harmful in rare circumstances in which the body produces too much acid (e.g. Zollinger-Ellison Syndrome) or if a patient has an ulcer that needs to heal. As humans, the complex and finely tuned physiology of our bodies has evolved over millions of years to include the protective and vital acidic environment in our stomachs. This is not accidental—our body needs these acidic juices produced by parietal cells in the lining of our stomach to digest food, protect us from potentially harmful microbes and communicate via complex feedback mechanisms with the rest of our digestive tract to optimize gut motility and nutrient absorption. In fact, treatment with a PPI has been associated with infections (pneumonia, c. difficile colitis, possibly common viruses), nutritional deficiencies (such as magnesium, iron, B12), osteoporosis, interstitial nephritis, gastric polyps and possibly small intestinal bacterial overgrowth (SIBO). Small intestinal bacterial overgrowth has been implicated in the development of irritable bowel syndrome, lower esophageal sphincter (LES) dysfunction (which causes reflux) as well as interfering with intestinal permeability—which itself has been linked in several studies to the development of autoimmune diseases such as Celiac Disease, Type 1 Diabetes and inflammatory bowel disease.
Since the pharmaceutical companies have initiated direct to consumer marketing of these agents and convinced both physicians and patients that PPIs are unquestionably safe for long term use, we will soon observe the negative effects of our flippant use of these powerful drugs globally. Both physicians and patients should exercise caution and common sense when using these acid reducing medications, and frequently reassess the need to continue these medications.
FDA urges healthcare providers and patients to report any adverse events or side effects that may be associated with the use of proton pump inhibitors to FDA’s MedWatch adverse event reporting program by phone at 1-800-F-D-A-ten-88 or by the Internet at www.FDA.gov/medwatch
To read more about how to treat reflux effectively, read the entries: GERD the solution and GERD evidence for the solution.
To read about why I believe that acid reducing drugs may not have any impact on your risk of developing esophageal cancer, read GERD drugs no help at all?
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