Long Term Use of Proton Pump Inhibitors

What are PPIs?

Proton pump inhibitors such as Omeprazole, Lansoprazole, Pantoprazole, Rabeprazole, Esomeprazole, are very effective medicines which reduce the amount of acid in the stomach.

Proton Pump Inhibitors (PPIs) reduce stomach acid and are commonly prescribed for:

·         Acid reflux and heartburn (GORD)

·         Indigestion (dyspepsia)

·         Stomach or duodenal ulcers

·         Protecting the stomach when taking certain medicines (e.g., NSAIDs)

However, if used long–term they can cause unwanted side effects. Therefore, it is important that this treatment is reviewed regularly, and the dose reduced or stopped when appropriate.

What is acid reflux or indigestion (dyspepsia) and heart burn?

Indigestion (also known as dyspepsia), acid reflux, and heartburn may occur when stomach acid meets the food pipe (oesophagus) or stomach. Symptoms may include pain and/or a burning sensation in the chest wall, bloating, burping, feeling nauseous or vomiting.

What are proton pump inhibitors (PPIs)?

Proton pump inhibitors are a class of medication given to patients with dyspepsia, acid reflux or heartburn. They help reduce the amount of stomach acid production. Reducing stomach acid allows the body time to heal any inflammation or irritation in the oesophagus or stomach.

Why is long-term use a concern?

Long-term use of PPIs is considered to increase the risks of developing or masking several conditions including:

·         Low magnesium levels

·         Vitamin B12 deficiency

·         Bone fractures and osteoporosis

·         Kidney problems

·         Infections (such as pneumonia or Clostridium difficile)

·         Rebound acid symptoms if stopped suddenly

How to use PPIs safely

·         Take the lowest effective dose for the shortest possible time

·         Review treatment regularly with your doctor

·         Do not stop suddenly—reduce gradually to avoid rebound symptoms

Research has found that some people taking PPIs for more than 2 months can produce more acid (rebound acid) to compensate for these medications. Production of acid can be more than 80% higher than when they first started a PPI! This may mean your symptoms worsen when trying to stop

Lifestyle tips to reduce symptoms

·         Avoid or reduce smoking

·         Eat in moderation and at regular times

·         Eat 3-4 hours before bedtime

·         Avoid bending or laying down straight after eating

·         Elevate the head of your bed by 15-20cm

·         Reduce dietary intake of fat

·         If you are overweight, lose weight

·         Avoid tight clothing or belts

·         Avoid or reduce alcohol intake

·         Avoid food which cause symptoms, such as Spicy food, Acidic drinks and food, Chewing gum, Caffeinated drinks like cola, chocolate, and coffee

 

More information can be found on The Eatwell Guide - NHS website.

When to seek medical advice

·         Difficulty or painful swallowing

·         Vomiting blood or material that looks like coffee grounds

·         Black, sticky stools

·         Unexplained weight loss

·         Chest pain that worsens with exercise

References

·         NHS Guidance on PPIs: https://www.wsh.nhs.uk/CMS-Documents/Patient-leaflets/Gastroenterology/Proton-Pump-Inhibitors-PPIs.pdf

·         Aspen Medical Practice PPI Leaflet: https://www.aspenmedicalpractice.nhs.uk/wp-content/uploads/2024/02/Proton-pump-inhibitors-leaflet.pdf

·         PrescQIPP Bulletin: Safety of Long-Term PPIs: https://www.prescqipp.info/media/1646/b92-safety-of-long-term-ppis-21.pdf

·         NICE CG184: Dyspepsia and GORD Management: https://www.nice.org.uk/guidance/cg184

·         Barnsley CCG Guidance on PPIs: https://best.barnsleyccg.nhs.uk/media/5m3f4yfw/proton_pump_inhibitors_guidance_for_safe_and_effective_use.pdf