Proton Pump Inhibitor (PPI) Safety
Proton Pump Inhibitor (PPI) Safety
You may be taking one of the proton pump inhibitors (PPIs) for gastroesophageal reflux disease (GERD/GORD), acid reflux, or another digestive problem that involves an increase in stomach acid.
PPIs are the first choice of treatment for GERD/GORD. PPIs decrease the secretion of stomach (gastric) acid and are approved for the short-term treatment of GERD. There are both prescription and over-the-counter (OTC) PPIs. Three examples of PPIs are omeprazole, esomeprazole, and lansoprazole.
There is a lot of information about the risks of taking PPIs. When properly used, PPIs are very effective with few problems. However, there are risks associated with their continuous or long-term use. If a PPI is prescribed for a longer period of time, a healthcare provider should regularly assess your continued need, at least every year.
PPIs may be used for the following conditions and situations:
Heal or maintain healed erosive esophagitis. Erosive esophagitis is damage of the esophagus from gastric acid.
Treat GERD/GORD. GERD/GORD is the flow of gastric acid back into the esophagus.
Lower gastric ulcer risk associated with nonsteroidal anti-inflammatory drugs (NSAIDs). Taking NSAIDs increases the risk of damage to the lining of the stomach (gastric ulcer).
Combined with antibiotics, eliminate Helicobacter pylori (H. pylori) bacteria. H. pylori are bacteria that causes gastric and duodenal (first part of the small intestine) ulcers.
Treat, maintain healed, or lower risk of recurrent duodenal ulcer. Duodenal ulcers are damage to the lining of the first part of the small intestine.
Treat gastric acid hypersecretory conditions. A gastric acid hypersecretory condition means there is overproduction of stomach acid.
Increased Risk With PPI Use
There is an increased chance of some serious health problems with improper use of PPIs such as taking:
For an unapproved symptom or condition (e.g. abdominal pain or bloating)
If you have specific medical conditions or take certain medicines (e.g. medicine that prevents blood clotting)
For a longer period of time than instructed
At a higher dose than recommended
Recommendation In general, take PPIs for as short a period of time as possible, at the lowest effective dose.
Complications can occur when taking one of the PPIs, although it isn’t common. If a problem does occur, it is usually related to continuous or long-term use. It may also involve factors specific to an individual - e.g. having certain health problems or taking particular medicines. There has been a lot of research about the relationship between PPIs and many different conditions. Much of it is inconclusive, however there is some evidence of a link between PPIs and an increased risk of the following:
Bacterial gastrointestinal infections (e.g. Clostridioides difficile or C. diff)
Kidney disease (e.g. acute interstitial nephritis)
Discontinuing Long-term Therapy
Between 25% to 70% of people taking PPIs are not taking them properly. If you’ve taken a PPI for a long time, especially without much relief, you should talk with your doctor about your diagnosis and other treatment options.
Discontinuing a PPI must be done carefully due to the possibility of rebound acid secretion. Abruptly stopping PPIs after lengthy therapy may cause an actual increase in stomach acid at a level even higher than before starting the PPI.
There have been studies to determine how people should stop taking PPIs, however there isn’t agreement as to the best way. There are several different methods you might use.
You may be taking a PPI for a condition for which there isn’t evidence that it helps - for example, abdominal pain. You may be able to simply stop taking it without problems.
Gradually discontinuing the use of PPIs helps to prevent rebound acid secretion. It is often done over 2 weeks or more with either half daily dosing or full dosing every other day.
If you’re taking a PPI at a dose that is higher than what is recommended, you might lower the dose. One study looked at people whose GERD symptoms were controlled with high doses of PPIs. 80% of them could step down to recommended doses with few recurring symptoms.
PPIs decrease the secretion of stomach (gastric) acid and are approved for the short-term treatment of GERD.
General recommendation: Take PPIs for as short a period of time as possible, at the lowest effective dose.
Complications from taking one of the PPIs is usually related to continuous or long-term use.
Discontinuing a PPI must be done carefully due to the possibility of rebound acid secretion.