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Proton pump inhibitors (PPIs) are medications that people use to treat heartburn, acid reflux, gastroesophageal reflux disease (GERD), and stomach ulcers.
Although mild or occasional heartburn is often easy to manage using over-the-counter (OTC) antacids or by making some lifestyle changes, some people have more persistent or severe symptoms. In these situations, doctors often recommend PPIs.
PPIs are a very common type of medication. In fact, in 2015, one study found that 7.8% of U.S. adults were taking them for symptoms caused by excess stomach acid.
This article will look at PPIs in more detail, including their uses, benefits, and potential side effects.
Doctors prescribe PPIs to treat stomach acid-related symptoms, such as heartburn and acid reflux.
Sometimes, these symptoms will occur due to an underlying condition. Common underlying causes of chronic heartburn and acid reflux include:
- stomach ulcers, or a Helicobacter pylori infection
- hiatal hernias
- lower esophageal sphincter dysfunction
PPIs work by reducing stomach acid levels, inhibiting the amount that the parietal cells in the stomach lining can make. This reduces heartburn and acid reflux and makes it easier for stomach ulcers to heal.
People should take PPIs on an empty stomach before meals. Stomach acid helps release the active ingredients so that they can prevent symptoms before they start.
There are many different PPI medications available in the U.S. The International Foundation for Gastrointestinal Disorders say that the various types are all similarly effective.
The two oldest PPIs, lansoprazole (Prevacid) and omeprazole (Prilosec), are available without a prescription. This is also true for esomeprazole (Nexium) and omeprazole (Zegerid), which combines omeprazole with an antacid.
However, doctors advise people not to use OCT PPIs for more than 14 days without talking to a physician. Needing to use them for this long could indicate that a person’s symptoms are due to a larger or more serious issue.
Other PPIs include:
Most people can take PPIs without any problems. According to the International Foundation for Gastrointestinal Disorders, only 1–2% of people taking them experience any side effects.
Even though side effects are rare overall, the most common seem to be:
People who experience side effects with one PPI may find that it helps to switch to a different brand.
However, long-term PPI use may carry some potential risks, including:
- wrist, hip, and spine fractures
- hypergastrinemia, or high levels of the hormone that stimulates gastric acid production
- community-acquired pneumonia
- Clostridium difficile, Campylobacter, and Salmonella infections
- hypomagnesemia, or very low levels of magnesium
- low levels of vitamin B-12
- acute interstitial nephritis, or sudden inflammation and injury of the kidneys
- drug-induced lupus erythematosus
Although some of these conditions are serious, researchers note that the studies about these risks do not always prove a cause-and-effect relationship.
Until there is more research into how PPIs affect the body over time, doctors should exercise caution when prescribing them long-term.
The National Institute of Diabetes and Digestive and Kidney Diseases state that PPIs are more effective than histamine2 (H2) antagonists in controlling GERD and helping the esophagus heal.
H2 antagonists, also known as H2 blockers, are an older class of drugs that people can use to treat ulcers, heartburn, and GERD. They are cheaper than PPIs but not as powerful. Studies show that PPIs are more effective at healing gastric and duodenal ulcers.
As a result, doctors tend to recommend OTC, lower-dose versions of H2 antagonists for people who have occasional heartburn.
The amount of time it takes for them to work and the length of time for which they are effective are two key differences between these medications.
H2 antagonists work more quickly than PPIs, but they only work for around 12 hours, which is why doctors recommend them more often for people with infrequent heartburn.
By comparison, PPIs can be effective for 24 hours, but they take longer to work.
PPIs are some of the most widely prescribed medications in the U.S. They are effective for treating the symptoms of heartburn, GERD, and stomach ulcers, among other conditions.
However, some studies indicate that long-term use of PPIs increases the risk of serious complications, including broken bones and pneumonia. People with chronic stomach acid problems should work with their healthcare providers to determine the best option for them.