Don’t be afraid of the Purple Pill: The Proton Pump Inhibitors (PPIs)

Medications for heartburn such as Prilosec and Nexium, known as PPIs, have received a lot of bad press lately.

First: a bit of history. PPIs have been taken by millions of patients every day for over 30 years. Prior to 1988, the only treatment for GERD (whose main symptom is heartburn) was a class of medications called H2 blockers. This class includes medications like Pepcid AC, which is still available over the counter (OTC). H2 blockers are fine for people with mild occasional symptoms of heartburn. However, many patients with GERD have daily symptoms which can result in significant damage to the esophagus leading to inflammation, ulceration, scarring and even pre-cancerous changes (Barrett’s Esophagus). H2 blockers cannot treat GERD when it is this severe or frequent. Only PPIs can give consistent symptom relief, and prevent complications.

So what changed? 

Over the last few years studies have come out suggesting that this class of medications is not safe. They have cited a number of potential problems, including kidney disease, increased risk of heart attack, dementia and broken hips.

The problem with these studies is that they are Observational studies. Data-crunching leads to a mistaken conclusion that association implies causation. The error with this type of study is that just because it shows that a certain percentage of people on PPIs had an increase in heart disease, it doesn’t mean that the PPI caused the heart disease. These Observational studies can’t control for what other factors the patient could have which may have increased their risk.

As Big Data gets analyzed, such observational associations result in front page news which is often sensational and creates a big splash. Unfortunately patients read this and stop their PPIs without discussing it with their Doctor. The net result is that we are now seeing a return of the bad old days of GERD causing severe ulcerations, stricture, and cancer.

What should patients on PPIs do? 

Please speak with your physician and re-discuss why you were placed on them in the first place, and if you still need it. Were they started by your primary care physician during a time where you were having heartburn but now your medical condition has improved? Have you lost weight and changed your diet? If so, maybe you can stop them safely.

On the other hand, were they started by a Gastroenterologist after an upper endoscopy (EGD)? If so, we strongly recommend that you do not stop the PPIs. The odds are if your Gastroenterologist started you on the PPIs, you need to be on them and you may be placing your health at risk if you stop them suddenly.

The bottom line? 

The PPIs are a remarkable class of medications which have helped millions and are extremely safe for the vast majority of patients. The decision to stop any prescription should be made in consultation with your doctor.


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