Do Proton Pump Inhibitors Work for Acid Reflux (GERD)?

· ·

By triggering withdrawal symptoms that mimic the original condition, these risky drugs keep patients hooked for years.

Discuss
Languages

    Selecting a language opens the video on YouTube with captions enabled.

  • English
Republish

Below is an approximation of this video’s audio content. To see any graphs, charts, graphics, images, and quotes to which Dr. Greger may be referring, watch the above video.

Have you heard of GERD? Gastroesophageal reflux disease (GERD) is one of the most common disorders of the digestive tract, and has been on the rise in the United states. The usual symptoms include heartburn and the regurgitation of stomach contents back up toward the throat, which can leave a sour taste in the mouth. GERD causes millions of doctor visits and hospitalizations each year, and represents the highest annual cost of any digestive disease in the United States.

Chronic inflammation caused by acid reflux can lead to Barrett’s esophagus, a precancerous condition that involves changes in the esophageal lining that can turn into adenocarcinoma, the most common type of esophageal cancer in the United States. Even without the cancer risk, GERD itself can cause pain, bleeding, and narrowing of the esophagus from scar tissue that can interfere with swallowing. Nocturnal symptoms can be managed by eating dinner earlier, using a foam wedge to elevate your head in bed, and sleeping on your left side, but what can we do to prevent acid from creeping up in the first place?

There are PPIs, stomach acid–blocking “proton pump inhibitor” drugs with brand names like Prilosec, Prevacid, Nexium, Protonix, and AcipHex, but their use comes at a cost exceeding the tens of billions of dollars spent on them every year. In 2010, the U.S. Food and Drug Administration issued a safety alert implicating PPI use with fractures of the hip, wrist, and spine. By now, there have been two dozen such studies including more than two million people that, overall, show higher hip fracture rates among both short- and long-term users––at all dose levels.

The irony is that most people taking these drugs shouldn’t even be on them in the first place. The FDA approved the use of PPIs for ten days for the treatment of Helicobacter pylori (a kind of stomach infection), up to two weeks for heartburn, up to eight weeks for acid reflux disease, and for two to six months for ulcers. Yet, most patients in a community survey said they remained on the drugs for more than a year. And most report they were taking them for inappropriate reasons. PPIs are often wrongly prescribed for indigestion, for example. The risks of these drugs almost always exceed their benefits over the long run. Calls from regulatory authorities to stop this overuse have fallen on deaf doctor ears. Now that PPIs are available over the counter, the problem of overuse has almost certainly gotten worse.

And once you start taking them, it can be hard to stop. Between 44 and 59 percent of patients experience withdrawal symptoms that can last for weeks. When healthy, symptom-free volunteers were placed on these drugs for two months and then covertly switched to a placebo without their knowledge, many of them suddenly, out of nowhere, developed acid-related symptoms like heartburn or acid regurgitation. So the drugs caused the very disease that many people take them to treat. As one review asking “Are PPIs Addictive?” noted, when patients stop taking them and their symptoms come raging back, the cause may not be their acid reflux, but the drug itself. You can see why they’re such blockbuster moneymakers for drug companies, because they can keep you hooked by effectively making your symptoms worse any time you try to stop them.

In addition to higher rates of bone fractures, this class of drugs has been linked to increased risk of other long-term adverse effects, such as kidney damage, pneumonia, intestinal infections, colitis, cancer, and cardiovascular disease. (The effect of PPIs on blood vessels explains the recent case report “Abrupt-Onset, Profound Erectile Dysfunction in a Healthy Young Man After Initiating Over-The-Counter Omeprazole (Prilosec)”.) They also increase the risk of premature death. Wait, do proton pump inhibitors really increase mortality? A careful appraisal of the totality of available evidence suggests that, indeed, long-term use likely increases the risk of dying prematurely.

Perhaps the better strategy would be to just keep the acid in its place by minimizing the intake of foods and beverages that enable acid to escape. I’ll cover that, next.

Please consider volunteering to help out on the site.

Motion graphics by Avo Media

Below is an approximation of this video’s audio content. To see any graphs, charts, graphics, images, and quotes to which Dr. Greger may be referring, watch the above video.

Have you heard of GERD? Gastroesophageal reflux disease (GERD) is one of the most common disorders of the digestive tract, and has been on the rise in the United states. The usual symptoms include heartburn and the regurgitation of stomach contents back up toward the throat, which can leave a sour taste in the mouth. GERD causes millions of doctor visits and hospitalizations each year, and represents the highest annual cost of any digestive disease in the United States.

Chronic inflammation caused by acid reflux can lead to Barrett’s esophagus, a precancerous condition that involves changes in the esophageal lining that can turn into adenocarcinoma, the most common type of esophageal cancer in the United States. Even without the cancer risk, GERD itself can cause pain, bleeding, and narrowing of the esophagus from scar tissue that can interfere with swallowing. Nocturnal symptoms can be managed by eating dinner earlier, using a foam wedge to elevate your head in bed, and sleeping on your left side, but what can we do to prevent acid from creeping up in the first place?

There are PPIs, stomach acid–blocking “proton pump inhibitor” drugs with brand names like Prilosec, Prevacid, Nexium, Protonix, and AcipHex, but their use comes at a cost exceeding the tens of billions of dollars spent on them every year. In 2010, the U.S. Food and Drug Administration issued a safety alert implicating PPI use with fractures of the hip, wrist, and spine. By now, there have been two dozen such studies including more than two million people that, overall, show higher hip fracture rates among both short- and long-term users––at all dose levels.

The irony is that most people taking these drugs shouldn’t even be on them in the first place. The FDA approved the use of PPIs for ten days for the treatment of Helicobacter pylori (a kind of stomach infection), up to two weeks for heartburn, up to eight weeks for acid reflux disease, and for two to six months for ulcers. Yet, most patients in a community survey said they remained on the drugs for more than a year. And most report they were taking them for inappropriate reasons. PPIs are often wrongly prescribed for indigestion, for example. The risks of these drugs almost always exceed their benefits over the long run. Calls from regulatory authorities to stop this overuse have fallen on deaf doctor ears. Now that PPIs are available over the counter, the problem of overuse has almost certainly gotten worse.

And once you start taking them, it can be hard to stop. Between 44 and 59 percent of patients experience withdrawal symptoms that can last for weeks. When healthy, symptom-free volunteers were placed on these drugs for two months and then covertly switched to a placebo without their knowledge, many of them suddenly, out of nowhere, developed acid-related symptoms like heartburn or acid regurgitation. So the drugs caused the very disease that many people take them to treat. As one review asking “Are PPIs Addictive?” noted, when patients stop taking them and their symptoms come raging back, the cause may not be their acid reflux, but the drug itself. You can see why they’re such blockbuster moneymakers for drug companies, because they can keep you hooked by effectively making your symptoms worse any time you try to stop them.

In addition to higher rates of bone fractures, this class of drugs has been linked to increased risk of other long-term adverse effects, such as kidney damage, pneumonia, intestinal infections, colitis, cancer, and cardiovascular disease. (The effect of PPIs on blood vessels explains the recent case report “Abrupt-Onset, Profound Erectile Dysfunction in a Healthy Young Man After Initiating Over-The-Counter Omeprazole (Prilosec)”.) They also increase the risk of premature death. Wait, do proton pump inhibitors really increase mortality? A careful appraisal of the totality of available evidence suggests that, indeed, long-term use likely increases the risk of dying prematurely.

Perhaps the better strategy would be to just keep the acid in its place by minimizing the intake of foods and beverages that enable acid to escape. I’ll cover that, next.

Please consider volunteering to help out on the site.

Motion graphics by Avo Media

Doctor's Note

Isn’t that wild about the withdrawal? The fact that the pills can actually cause the very symptoms you’re trying to fix? How diabolical for Big Pharma to try to keep you hooked on drugs that shouldn’t even be taken long-term. 

This is the first in a three-video series. Stay tuned for The Best Diet for Treating Acid Reflux (GERD) and The Health Benefits of Psyllium, Flaxseeds, and Other High-Fiber Foods.

For even more on pain management, check out my new book How Not to Hurt, available now for preorders. (All proceeds received from book sales are donated directly to charity.)

If you haven't yet, you can subscribe to our free newsletter. With your subscription, you'll also get notifications for just-released blogs and videos. Check out our information page about our translated resources.

Subscribe to our free newsletter and receive the the Maximally LDL-Lowering Daily Dozen checklist from Dr. Greger's Lower LDL Cholesterol Naturally with Food book.

Previous Video

HOW NOT TO HURT Trailer for Dr. Greger’s New Book on Chronic Pain Relief

Pin It on Pinterest

Share This