Are PPI's Safe?
Recently, I have seen several TV news stories and newspaper articles about the safety of Proton Pump Inhibitors or PPI's, a popular medication to treat Gastroesophageal Reflux Disease or GERD. You may be more familiar with the brand names of PPI's such as Nexium, Prevacid, Prilosec or Protonix.
New research was presented at a large gathering of gastroenterologists attending the Digestive Disease Week Conference. While there have been earlier studies indicating an increased risk of pneumonia and hip fracture in adults taking PPI medications, the new studies confirmed the earlier data.
I have been getting plenty of questions from concerned parents of children on PPI's as well as adults with GERD. Here are the common questions and answers.
Are PPI's safe?
Generally, PPI's have an excellent history of mild side effects and are easily tolerated by most children and adults with GERD. Further, PPI's have been shown to reduce acid, heal damage to the esophagus and decrease symptoms of GERD. Keep in mind that all medications, whether it is an over the counter medication or prescription have the potential for side effects.
Should I stop taking PPI's?
Keep taking your medication for now and check in with the prescribing doctor for information and advice. Many doctors will give a short term prescription for a PPI to confirm a diagnosis of GERD. After a few weeks, call the doctor or schedule an appointment for follow up. Ask the doctor if the PPI is still needed to treat the symptoms. For infants and young children, the medication should be reviewed at each well check up and visit to the gastroenterologist. For adults taking a PPI for long term management of GERD, most doctors want to follow up every 6 months or once a year.
How can I reduce my risk of side effects?
Many children and adults benefit from PPI's to manage GERD. Ask your doctor about other treatments to reduce symptoms such as diet, elevating the bed for sleeping, losing weight if overweight and stepping down to other medications. Over time, it may be possible to wean off of PPI's and manage reflux in other ways. Sometimes it is possible to take GERD medication as needed rather than every day. Certainly if there is damage to the esophagus or Barrett's esophagus, daily medication may be needed regardless of lifestyle changes.
There is plenty of evidence that non medication treatments are just as effective as medication for treating mild reflux symptoms. Whether you have mild reflux or severe reflux, it is always best to change your diet and lifestyle to reduce symptoms as much as possible.
Some doctors are concerned that PPI's are being over prescribed. That is why it is important to work with your doctor to make sure the PPI's are really needed to treat the symptoms. After long term use of PPI's, the doctor may ask you to take a "medication holiday" for a few weeks and see if the symptoms return.
I know readers get tired of hearing me say go to the doctor for a diagnosis and treatment plan. There are so many medical conditions with symptoms that look like reflux. I think it is really important to work with your doctor to get a proper diagnosis and treatment plan. It really doesn't make sense to take a medication if it isn't needed.
How can I protect my bones if I need to take PPI's?
There is increasing evidence that both children and adults need more Vitamin D and calcium in their diet. While it is best to get these nutrients from a balanced diet, a vitamin is also a good way to ensure proper nutrition. Some children and adults may need extra monitoring by the doctor to check for osteopenia and osteoporosis if PPI's are necessary for long term treatment or used in high doses.
Should I have surgery instead?
Diet, lifestyle changes and medication are still considered the best treatments for GERD. While there are several less evasive, incisionless surgical treatments available, a non surgical approach is recommended in the vast majority of cases for children and adults with GERD. Research is also looking at medication to address motility, the underlying cause of reflux. Medicine is always changing as new research helps us understand the mechanism for illnesses and new treatments.
Have a baby or child on a PPI? Taking a PPI? What are your questions and concerns?