Heartburn Help: Proton Pump Inhibitors Being Overprescribed?

Minneapolis, MNFor many people, proton pump inhibitors have been like a miracle drug. But the heartburn drugs may have worked too well, putting patients at risk of developing proton pump inhibitor side effects. Because they reduce the effects of acid reflux, allowing people to eat foods they possibly should not be eating, many people started taking the proton pump inhibitors (PPIs) long-term. Unfortunately, when taken long-term, patients are at a higher risk of developing PPI side effects, which include an increased risk of fracture.

According to an article in the Star Tribune (10/02/10), there were more than 119 million prescriptions written for proton pump inhibitors—a class of drugs that includes Prevacid, Nexium and Prilosec—in 2009. That 119 million does not include sales of over-the-counter versions of the proton pump inhibitors.

The issue, though, is whether people need to take so many proton pump inhibitors, especially given the serious PPI side effects. In some situations, the patient might do better to stop eating certain foods rather than taking a medication to mask the problem. That way, the patient is not put at risk of developing side effects from using proton pump inhibitors long term.

Furthermore, because the proton pump inhibitors work so well, some patients might take them on a daily basis for the long-term to prevent any issues of gastroesophageal reflux disease (GERD)--commonly called acid reflux or heartburn--from arising.

Speaking with the Star Tribune Dr. Marcus Thygeson, a gastroenterologist, says proton pump inhibitors are "like front-line therapy if you so much as belch," and notes that the pills are "handed out like water."

Acid reflux occurs when the liquid content of the stomach backs up into the esophagus. This liquid, which often contains acid and pepsin and can contain bile, can inflame the lining of the esophagus. Acid reflux is a chronic condition and is thought to occur frequently in the population. Patients who have GERD, however, may have a higher concentration of acid in the liquid that backs up to the esophagus.

Some foods, including fatty foods, chocolate, alcohol and caffeinated beverages, reduce pressure in the lower esophageal sphincter. That sphincter is responsible for preventing liquid from backing up into the esophagus—with reduced pressure, the sphincter is less effective and acid reflux is more likely to occur. Therefore, patients who suffer GERD are often advised to change their diets.

Unfortunately, because proton pump inhibitors work so well, they are often seen as the easier alternative, despite reported side effects. Patients who take proton pump inhibitors for more than a year (in the case of prescription proton pump inhibitors) or more than 14 days continuous use (in the case of over-the-counter proton pump inhibitors) are at an increased risk of serious PPI side effects including fractures, including hip, wrist and spine fractures.