What you should know about: PPIs

If you suffer from chronic heartburn or another digestive disorder, you may have been prescribed a proton-pump inhibitor (PPI), which helps reduce the production of stomach acid. There are several different types of PPIs. Prescription-only PPIs include esomeprazole (Nexium) and pantoprazole (Protonix). Some PPIs are also available over the counter, including lansoprazole (Prevacid) and omeprazole (Prilosec).

How they work

PPIs work by inhibiting certain stomach cells from “pumping” acid into the stomach. When taken 30 to 60 minutes before a meal, PPIs can prevent or reduce heartburn. However, they do not work as well when taken on demand as they do when taken over a period of time. And while PPIs are generally safe when used in the short term, they do carry some risks in the long term. Unfortunately, the medications tend to be overused. “I think a lot of people get heartburn from taking medications or ingesting certain food and drinks. To treat their symptoms they get PPIs over the counter or from their physicians,” says Dr. Jacqueline Wolf, associate professor of medicine at Harvard Medical School.

Acid Reflux (heartburn)

Acid Reflux (heartburn)

To reduce heartburn risk:

  • Avoid eating within two to three hours of bedtime.
  • Eat smaller meals.
  • Stop smoking.
  • Decrease caffeine.
  • Raise the head of your bed.
  • Avoid mint, carbonated drinks, sparkling water, alcohol, onions, garlic, citrus, and tomato.

Side effects and interactions

Prolonged use of PPIs may lower your body’s levels of vitamin B12, which is important for healthy brain and nerve function. They may also reduce your body’s ability to absorb calcium, which could lead to weaker bones and a greater risk of hip fracture. PPIs also increase the risk of pneumonia and other life-threatening infections, such as Clostridium difficile infection, which causes gastrointestinal disease. Some studies have suggested that PPIs interfere with clopidogrel (Plavix), a blood thinner. However, other studies have challenged this conclusion. Despite these concerns, Dr. Wolf believes that PPIs, when used for brief periods, can be helpful for people with conditions such as chronic acid reflux, which occurs when stomach acid emerges up from the stomach into the esophagus. “I think they’re worth the risk, because chronic reflux can cause inflammation, ulcers, or changes in the cells of the esophagus,” she explains. “Or you can have trouble swallowing, or develop hoarseness and a cough. Also, people just get very uncomfortable. We [physicians] should all be aware of it, get the person comfortable and then try to taper them off.”

Tapering off

Stopping PPI use suddenly may cause a rebound effect with stomach acid. So Dr. Wolf recommends replacing a PPI with a similar drug, known as an H2 blocker, one day a week, and then two, and so on until you’ve stopped taking the PPI. H2 stands for histamine2, a chemical that signals the stomach to produce acid, and H2 blockers are often easier to stop using than PPIs. H2 blockers include famotidine (Pepcid), ranitidine (Zantac), cimetidine (Tagamet), and nizatidine (Axid). “But the most important thing of all is to make lifestyle changes if you have reflux,” says Dr. Wolf.

Bible verses for today’s meditation and inspiration: Matthew E. McLaren

Psalm 38:3 There is no soundness in my flesh because of Your indignation; There is no health in my bones because of my sin.
Matthew 9:12-13 But when Jesus heard this, He said, “It is not those who are healthy who need a physician, but those who are sick. “But go and learn what this means: ‘I DESIRE COMPASSION, AND NOT SACRIFICE,’ for I did not come to call the righteous, but sinners.”

Luke 5:31-32 And Jesus answered and said to them, “It is not those who are well who need a physician, but those who are sick. “I have not come to call the righteous but sinners to repentance.”

Exodus 15:2 “The LORD is my strength and song, And He has become my salvation; This is my God, and I will praise Him; My father’s God, and I will extol Him.

Acts 3:16 “And on the basis of faith in His name, it is the name of Jesus which has strengthened this man whom you see and know; and the faith which comes through Him has given him this perfect health in the presence of you all.

Exodus 23:25 “But you shall serve the LORD your God, and He will bless your bread and your water; and I will remove sickness from your midst.

Be anxious for nothing, but in everything by prayer and supplication with thanksgiving let your requests be made known to God.
Psalm 32:4-5 For day and night Your hand was heavy upon me; My vitality was drained away as with the fever heat of summer. Selah. I acknowledged my sin to You, And my iniquity I did not hide; I said, “I will confess my transgressions to the LORD”; And You forgave the guilt of my sin. Selah.

Psalm 149:4 For the LORD takes pleasure in His people; He will beautify the afflicted ones with salvation.

1 Thessalonians 5:9 For God has not destined us for wrath, but for obtaining salvation through our Lord Jesus Christ,

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