We are delighted to see more and more of our members and visitors to RefluxMD interested in stopping daily long-term use of PPI medications. Well before RefluxMD was formed, our medical advisors had been very vocal about the inappropriate use of PPI drugs and the potential long-term side affects of these medications, both OTC and prescription. In fact, Dr. Tom DeMeester wrote an article published in the Huffington Post (Acid Reflux Problem? The Warning On The Pill’s Label Says Use for 14-days) that highlighted his concerns. For all of those on daily PPIs, we hope this information helps you to wean off of these medications.
I liked your article Rebound Acid Secretion: What To Expect If You Reduce Your PPI Use. I was diagnosed with GERD (2000) however recently I had my gallbladder removed (was probably malfunctioning during GERD diagnosis) and suspect that the gallbladder not functioning normally influenced the GERD issues. I am trying to wean myself from the PPI meds (10+yrs of use) by using a step down approach (PPI to H2 to tums) with the idea that my stomach will return to its normal mode of operation with time. I cannot find any articles that specifically provide an approach to do this. I would like to see a study that addresses this subject. There are others like myself that could benefit from this.
Thank you for your questions and I applaud you for your efforts to go “PPI Free.” However, having taken these medications for such a long period of time, we encourage you to make this change slowly, deliberately, and under the care of your physician. PPI medications, either OTC or prescription, work by inhibiting the acid production (up to 99%) in the stomach. This is an excellent tool to heal stomach ulcers and reduce the pain from GERD, but the reduced acid level in the stomach inhibits digestion of proteins and blocks the absorption of nutrients. According to Sara Murphy MD and Hana Grobel MD, in an article about PPI use (Weaning GERD Patient off PPIs), the authors highlight their concern about long-term daily use of PPIs and the importance of normal acid levels in the stomach:
PPIs are valuable in the short-term treatment of GERD, but long-term use may lead to serious complications, including increased risk for pneumonia and Clostridium difficile, and decreased absorption of vitamin B12, calcium, magnesium and iron. Acid functions to kill bacteria in the stomach, and it helps break down food to make nutrients more available. In the duodenum, acid helps stimulate release of pancreatic enzymes, which further aid digestion. Higher acidity in the stomach also increases the tone of the lower esophageal sphincter. Thus, acid production plays an important role in tightening LES tone, getting rid of unwanted bacteria, and providing us with properly digested nutrients.
Eliminating daily use of PPI medications
We were greatly impressed with a video discussion between David Kiefer MD and David Rakel MD from the Integrative Medicine Program at the University of Wisconsin. Their topic, Integrative Strategies to Come Off a PPI, is an excellent overview and introduces some very interesting ideas using natural home remedies. We encourage you to watch this 9-minute video.
Step down approach to wean off daily use of PPI drugs
RefluxMD’s medical advisors developed a set of guidelines to reduce the use of daily PPIs via a step down approach. The following infographic provides an overview of their approach:
There are several important things to note before starting this step down program:
- Before you make medications changes, please consult with your physician.
- Make small and gradual changes to your medication.
- Remember your goal: stop the use of daily PPI drugs and find the least potent medication (H2 blocker or antacid) used at the lowest dose that will effectively control your symptoms.
- It is critical to implement both diet and lifestyle changes before you attempt to wean off these medications. Both diet and lifestyle changes are discussed on our website and in our free GERD guide.
- Your weight has an impact on GERD symptoms. If your BMI is not at 25 or less, consider a weight loss program prior to elimination of daily PPIs.
- Take it slow. Your body is adjusting to major changes so do not go too fast.
- There are no hard and fasts rules here. Since each of us is different, we will all respond differently to this process.
- If you find that your symptoms increase, take a step back or stop the process.
I hope this helps
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