Acid Reflux

Chronic Use Of Proton Pump Inhibitors Has Side Effects

Proton pump inhibitors (PPIs) can effectively treat gastro-esophageal reflux disease (GERD), erosive esophagitis, duodenal ulcers, and pathologic hyper-secretory conditions. Proton Pump Inhibitors or PPI’s include Prilosec, Nexium, Prevacid, Zegerid, Protonix and Aciphex. The mechanism of action is blocking stomach acid release.

Long-term use of PPI’s is associated with increased risk of all cause mortality in two cohort studies of institutionalized older persons, as well as other possible adverse effects. These include:

• Clostridium Difficile infection (a bacterial infection of Gastro-Intestinal tract with prolonged diarrhea.
• Community acquired pneumonia and hospital acquired pneumonia.
• Fractures of the hip, wrist, and spine
• Gastric acid rebound or reflux symptoms after discontinuation of PPI’s
• Iron deficiency
• Major adverse cardiac events in the year following angio-catherization procedure in those taking Plavix. The Plavix label recommends avoiding concurrent use of Prilosec because it decreases the effectiveness of Plavix.

Adults older than 65 are at a higher risk of these adverse effects because of the higher prevalence of chronic diseases in this population.

If you are a long-term user of PPI’s try to seek out an alternative to chronic PPI use.

At my clinic, the patient with GERD will be given dietary recommendations such as chew your food well (at least 25-50 times per bite), eat small frequent meals, and avoid excessive fat intake. Do not eat large amounts close to bedtime. Avoid caffeine, alcohol, and other symptom-evoking foods. In addition to doing blood testing for food sensitivities, I also put every patient on an elimination diet. This helps to discover any particular food that might be the culprit of the problem. Avoidance of these allergenic foods can be very helpful. I also do special testing for intestinal candidiasis or yeast, and when found, the patient is placed on a candida diet which can also bring about dramatic symptomatic improvement. Finally, I also look for hormonal imbalances which if found and corrected can also bring about a solution to a chronic condition. Various supplements are also prescribed that have been studied scientifically and found to be of benefit to patients with GERD.