I have been taking PPIs for some time. I haven’t had any symptoms in a while, so I’m wondering if I can stop taking the medication? What do you think is the best medicine for acid reflux?
While taking prescription medications, such as PPIs, you should always follow the recommendations of your physician. Below are issues that relate to your question.
The purpose of PPIs, H2 blockers (such as Zantac), and antacids (such as Tums) is simple: to relieve or control your GERD symptoms. These drugs either limit the production of acid by the stomach or neutralize the acid that is already there. They do not stop or even reduce the reflux of stomach contents into the esophagus. You just may not “feel it” since the irritant – acid – is removed.
When asked about the best medicine for acid reflux, we can only respond by saying that the goal is to use the least powerful drug taken as infrequently as possible to control these symptoms in a satisfactory way. PPIs, in particular, carry significant long-term side effects, so it is desirable to get off of them, if possible. There is nothing magical about taking a PPI once a day when your symptoms can be controlled with an H2 blocker or antacid taken when needed. In addition, many people are able to control their symptoms and either discontinue or dramatically reduce their drug requirement by making smart dietary and lifestyle modifications.
There are indeed, some patients whose symptoms are completely relieved while on a PPI, who try reducing the frequency or changing to a less potent medication. Reducing PPI dosage should be done slowly. Suppressing stomach acid causes changes to specific enzyme levels in the blood stream. There is some evidence that that the rapid withdrawal of PPIs can actually cause symptoms of reflux.
Some patients end up requiring acid reducing medications on an as-needed basis, such as just before a meal that they know typically causes heartburn. This is probably the optimal situation. The medication is taken when the symptom exists and not to additional excess.
Long-term PPIs and any adjustments of dose or frequency should be done only under the supervision or advice of a qualified physician.