We’ve heard this question a lot over the last year from our members and visitors. When we started RefluxMD it was difficult to find even one story about the potential negative side affects of PPI therapy. Today we see several articles and/or research reports weekly on these topics. As more adults become aware of the potential problems with these medications, they look for alternative means to manage their symptoms. If you have considered life without daily reflux medications, you should find this response interesting.
After an endoscopy I had in November 2014 I was placed on PPI’s (Nexium), but I stopped using them after finding out about the side effects of these drugs. I don’t know what to do; I have heartburn every minute of the day. What do you suggest?
Thank you for your question and I am so sorry for your pain. I noticed in your GERD Stage Assessment that a specialist diagnosed you with GERD and that you have experienced heartburn and regurgitation more than once weekly for several years. However, I am concerned that during the last year you experienced new symptoms: hoarseness, a persistent cough, and/or constant throat clearing weekly. Those new symptoms, typical of LPR or silent reflux, suggests that your vocal cords and larynx may now be impacted by your acid reflux. It is clearly time to take action and you should consider seeing a GERD expert to get a second opinion and to discuss all your treatment options. Your daily heartburn is a message not to delay – take action as soon as possible and find the relief you need. I hope the comments below will help you and others seeking to avoid daily PPI medications to reduce the symptoms of acid reflux.
PPI therapy for managing symptoms
For many, daily PPI therapy is an effective tool for symptom relief. However, our medical advisors are concerned with this “status quo” treatment model when these medications are used daily over the long-term. They certainly have an important role in the management of GERD, such as treating esophagitis for example. However, daily PPI therapy reduces the acid level (raise the pH) in the stomach by shutting down the parietal cells in the stomach. These cells create hydrochloric acid that kills bacteria and aids in the digestion of food, very important elements for good digestive health. Reducing this acid production in the stomach will reduce or eliminate heartburn for most adults since it is typically the acid reaching the lining of the esophagus that creates this pain. However, with reduced levels of hydrochloric acid, harmful bacteria can grow as well as inadequate digestion of food resulting in poor nutrition.
As a result, the FDA has issued warnings on long-term daily PPI thearpy for several reasons as discussed in our article, What you should know before taking PPIs:
- Reduced calcium absorption that can lead to bone fractures.
- Reduced magnesium absorption that can create cardiac issues.
- Higher incidence of pneumonia.
- Increased incidence of a bacterial infection, Clostridium difficile (C diff).
- Increased risk of dementia, heart attack and kidney disease.
RefluxMD and our medical advisors are also concerned that in the absence of GERD symptoms due to PPI use; most adults are led to believe that they are “cured”. Unfortunately, these medications only mask the symptoms of GERD, but they do not stop reflux from occurring, and they cannot stop the disease from progressing. As Dr. Tom DeMeester pointed out in his Huffington Post article titled, Acid Reflux Problem? The Warning Label On the Pill’s Label Says Use for 14 Days: “According to a study by Dr. Blair Jobe at the University of Pittsburg, PPI-treated GERD patients, who have mild or absent symptoms while on the medication, were 60 percent more likely to have Barrett’s esophagus, a precancerous condition, than those with more severe symptoms while on the medication.”
We only recommend weaning off of PPIs under the care of a physician and following a step-down program such as the process developed by our medical advisors. There are serious consequences to reducing or stopping PPI too quickly resulting in severe pain. If you need a GERD expert to assist you in this process, please use our Find a GERD expert online tool.
There are several other options to consider for symptoms management
We have many articles and suggestions on our website concerning the following suggestion for anyone seeking to reduce or eliminate their GERD symptoms as well as a step-down process to stop PPI therapy. We think all alternatives, especially diet, weight management, and lifestyle changes, should be considered in an effort to find relief and good health.
Work with a GERD Expert
Self-diagnosis along with self-medication is not advisable given the potential complications of disease progression. Likewise, family doctors and primary care physicians are unable to perform the necessary tests to be certain of a GERD diagnosis. If you have any GERD symptoms on a weekly basis, we highly recommend you see a GERD expert. You can use our Find-A-Physician search tool or DocMatch to locate a GERD expert near you.
Many doctors and researchers believe that obesity is driving the increased incidence of GERD since a distended belly puts pressure on the diaphragm. This can result in a shorter and weaker lower esophageal sphincter (LES), the valve that keeps stomach contents from reaching the esophagus. Consequently, when GERD sufferers limit their portion size and reduce their weight to a body mass index (BMI) of 24 or less, many find some level of symptom relief. For anyone with a BMI of under 27, we hope you will consider RefluxMD’s Recipe for Relief as you build your plan achieve a healthy BMI. For those excessively overweight or obese, we encourage you to learn more about Scale Down for Relief.
What you eat, the size of each meal portion, and when you eat your last meal can significantly impact your GERD symptoms. RefluxMD recommends three small meals daily and two snacks, along with eating the last meal at least three hours before bedtime. Also, determine and avoid “trigger foods” and where possible, avoid foods that are fried or have a high fat content. We offer many articles in our diet section at RefluxMD.
There are many lifestyle changes that can impact your GERD symptoms including smoking cessation, reduced consumption of alcohol, raising the head of your bed by 7 inches, avoiding tight clothes that put pressure at the waistline, and sleeping on the left side if possible. We offer many articles in our home remedies and lifestyle section at RefluxMD.
RefluxMD encourages the use of least powerful medications (like antacids and H2 blockers) at the lowest dose needed to control symptoms. PPI therapy on an intermittent basis should not result in the negative side affects discussed above. However, when GERD progresses to later stages and or serious complications like Barrett’s esophagus, PPI use may be required on a daily basis. That is why we encourage everyone to seek the opinion of a GERD expert.
For those that want to treat the root cause of GERD – a damaged LES – antireflux surgery is an option. For those that are unable to manage their GERD symptoms by weight management, diet, lifestyle change, and/or medications, antireflux surgery may be the only option to find relief. To learn more about these options, read our articles in the surgical and procedural section of RefluxMD.
I hope this helps