Proton pump inhibitors are mostly known for managing acid reflux, a condition in which stomach acid refluxes back into the esophagus and causes heartburn. Not only can they ensure a higher quality of life to their users, but diminish the risk of further complications of acid reflux, including tooth decay and esophageal cancer. Conversely, a growing body of evidence suggests PPIs may have long-term side effects and cause significant health risks on their own.
What Are Proton Pump Inhibitors (PPIs)?
Medically known as proton pump inhibitors, PPIs are among one of the most commonly used drugs to treat gastroesophageal reflux disease (GERD), though are also used to heal stomach ulcers, or protect those at risk for one after long-term use of anti-inflammatories or aspirin. Proton pump inhibitors work by blocking acid production in the stomach to ultimately calm symptoms, along with treating damage to the lower esophagus caused by acid reflux. Frequently used PPIs include Prilosec (omeprazole), Nexium (esomeprazole), and Prevacid (lansoprazole) and may be purchased over-the-counter or prescribed by a primary care physician.
Side Effects of PPIs
Though initial side effects of PPIs may be rare, they are worth mentioning. Frequent warnings of PPI use include headache, diarrhea, constipation, nausea, itching, and cutaneous lupus erythematosus and systemic lupus erythematosus. However, side effects of long-term PPI use can be severe and include the following:
• Hip Fractures
Long-term use of Nexium may increase the risk of hip fracture. The relationship is tied to PPI’s interference with calcium absorption, the mineral responsible for strengthening bones.
• Low Magnesium Levels
Taking omeprazole for three months or longer raises the risk of low magnesium levels, with the risk growing if taking for more than a year. Low magnesium levels should not be taken lightly and can be indicated by seizures, abnormal or fast heart rates, jitteriness, jerking movements or shaking, and muscle weakness, aches, and cramps.
• Kidney Damage
The JAMA Internal Medicine found PPI users have a 20 to 50 percent higher risk of developing chronic kidney disease (CKD) compared to those who do not use it.
Research shows PPI use can compromise healthy bacteria, including in the respiratory tract. Long-term use of PPIs can increase the risk of pneumonia, a lung infection triggered by bacteria and viruses that causes the air sacs of the lungs to fill up with fluid or pus.
• Clostridium difficile Infection
PPIs may cause Clostridium difficile, a type of bacteria that can cause severe inflammation of the large intestine. The bacteria may lead to severe diarrhea and belly pain, even provoking the potential to be life-threatening if left uncontrolled and unmanaged.
The JAMA Neurology suggests participants who filled a PPI prescription at least once every three months were more than 40 percent more likely to develop dementia than their PPI-free counterparts.
• Premature Death
Startling new research discovered the longer the duration of PPI use, the greater the risk of premature death.
Reducing the Risk of Long-Term PPI Side Effects
With such risks of PPIs with and without their use, it may be confusing on whether or not PPIs are warranted. However, the upmost consideration regarding proton pump inhibitor use should reflect individualized needs, along with deliberating other treatment modalities. In fact, PPIs are not the only acid reflux medication available, as antacids and histamine antagonists (H2 antagonists and H2 blockers) are additional options.
But before reaching for the pill bottle too frequently and too soon, there are more holistic approaches to reduce the risk of acid reflux complications itself and the medications used to treat it. Viable modifications include reducing caffeinated and high-fat products, eating more frequent and smaller meals, managing stress, quitting smoking and tobacco use, and losing weight or maintaining a healthy one. More specifically, health experts propose even losing five to 10-pounds can reduce acid reflux symptoms, which can also be accomplished through lifestyle modifications, including consuming a nutritious diet, exercising regularly, and obtaining adequate sleep. Ultimately, a healthcare provider can gear personalized plans to ensure the upmost safety and effectiveness for GERD management.