Acid Reflux: Duration of Stomach Acid Blocker Therapy Varies

I have had acid reflux for many years. About six months ago, a doctor looked down my esophagus and into my stomach (a test he called an upper endoscopy) because the symptoms were getting worse. My esophagus was inflamed, and I was told to take pantoprazole indefinitely. But now I rarely have heartburn. Do I really need to stay on this medication forever?

pantoprazole
(Dreamstime/TNS)

Answer:

Pantoprazole is a proton pump inhibitor (PPI). Drugs in this class are the most potent stomach acid inhibitors. Other proton pump inhibitors include omeprazole, esomeprazole, lansoprazole, dexlansoprazole, and rabeprazole.

There is no simple yes or no answer to your question, but here is how I approach this very common situation.

My recommendation depends on some details about your reflux symptoms that I don’t have. Was the heartburn present for a long time before you had the endoscopy? Did you start the pantoprazole many weeks before the endoscopy last year?

The reason for these questions is to get a better picture of the severity of your esophageal inflammation (esophagitis). If your reflux was severe or you had been on treatment for a few weeks prior to the endoscopy, I would likely recommend continuing acid blocker therapy for a prolonged period of time.

If the inflammation was severe, then prolonged therapy with a proton pump inhibitor, such as pantoprazole, is warranted. Treating esophagitis is not just about controlling symptoms. Persistent severe inflammation of the esophagus from acid reflux can lead to scarring and narrowing of the lower esophagus. It also increases your risk of developing a condition called Barrett’s esophagus, which can lead to cancer.

However, most people with acid reflux can step down to less potent anti-acid medications. If you and your doctor decide it’s the right time to make a change from pantoprazole, you will want to wean yourself off the medication. You don’t want to just stop it abruptly because you would likely get rebound heartburn; your body is used to the acid blocker.

If you take the pantoprazole, or another proton pump inhibitor, twice a day, your doctor may suggest decreasing it to once per day. If you already take it once per day, you might take it every other day instead. On the “off” days, use an H2 blocker or antacids. Continue to slowly taper the medications.

Losing weight, not lying down after eating, and avoiding foods that typically cause your heartburn will often help.

Assuming the heartburn does not return when you taper off the proton pump inhibitor, you and your doctor can decide if another endoscopy is warranted to make sure the esophagitis has healed.

Key Takeaway: Most people with acid reflux can step down to less potent anti-acid medications, but consulting a doctor is important.

About the Author: Howard LeWine, M.D., is an internist at Brigham and Women’s Hospital in Boston and assistant professor at Harvard Medical School. For additional consumer health information, please visit www.health.harvard.edu.

Source: https://www.theepochtimes.com/health/duration-of-stomach-acid-blocker-therapy-varies_4867491.html

Proton pump inhibitors are overused with long-term risks, mounting research finds

Acid-reducing drugs, also called proton pump inhibitors (PPI), are one of the most successful drug classes ever launched, projected to earn as much as $3.26 billion in profits in the year 2026.

“Twenty-five years after their introduction into clinical practice, PPIs remain the mainstay of the treatment of acid-related diseases,” research published in the journal BMC Medical says. “Overall, PPIs are irreplaceable drugs in the management of acid-related diseases.”

The dementia risk of PPIs attracted attention in 2016 when an observational study by German researchers was published in JAMA Neurology. It linked regular PPI use with a 44 percent increased dementia risk compared to people not using the drugs.

The study was based on the medical records of 73,679 people ages 75 and older.

Research published in Current Gastroenterology Reports echoes the danger of vitamin and mineral deficiencies cited in the Journal of Neurogastroenterology and Motility.

The U.S. Food and Drug Administration (FDA) is aware of the risks, which grow with long-term usage. According to U.S. Pharmacist, “Since 2010, the FDA has issued various safety warnings regarding the potential effects of long-term use of PPIs,” not just the adverse events listed by the Journal of Neurogastroenterology and Motility, but also PPI-linked risks of fractures, clostridium difficile-associated diarrhea, and lupus-related events.

Because the drug class is intended to be used for the shortest time possible, the journal Gastroenterology warns that “patients with uncomplicated GERD who respond to short-term PPIs should subsequently attempt to stop or reduce them. Patients who cannot reduce PPIs should consider ambulatory esophageal pH/impedance monitoring [measuring the amount of acidic and non-acidic reflux in the esophagus during a 24-hour period] before committing to lifelong PPIs to help distinguish GERD from a functional syndrome.”

Cedars-Sinai, a nonprofit academic health care organization, points out that taking an acid blocker doesn’t address other GERD causes such as “being overweight, overeating, having caffeine and alcohol, and eating chocolate and spicy foods.”

And there is another potential adverse effect with PPIs according to U.S. Pharmacist: hypergastrinemia.

“This condition causes rebound hyperacidity; after discontinuing PPI therapy, patients may experience worsening GERD symptoms,” the publication says. “To avoid this, PPIs should be slowly tapered. In addition, hypergastrinemia can cause parietal cells to hypertrophy and enterochromaffin-like cells (ECL) [gastric secreting cells] to undergo hyperplasia.”

PPIs Linked to Contracting COVID-19

Because our stomach acid protects us from a lot of viruses and bacteria, some people, especially those in the medical field, weren’t too surprised when PPIs were linked to a greater risk of contracting COVID-19 when the pandemic began.

In 2020, the journal American Journal of Gastroenterology published a study from researchers affiliated with Cedars-Sinai Medical Center and Michigan Medicine that discussed the link.

“In a nationwide study of individuals with a history of GI symptoms, we found that the use of PPIs is associated with increased odds for reporting a positive COVID-19 test. The highest risk is seen among individuals taking PPIs twice daily—a common off-label practice in both primary and secondary care—because they are nearly 4-times more likely to report COVID-19 positivity when compared with those not on PPIs.”

Dr. Brennan Spiegel, one of the researchers and the study’s guarantor (a research author responsible for the integrity of the work as a whole) told Time: “Viruses like SARS-CoV-2 are capable of hijacking the gastrointestinal tract quickly. … It can invade, replicate and multiply efficiently. There is even a theory that maybe it uses the intestines as a kind of home base where it entrenches itself and then spreads throughout the body.”

The following year, the journal Gut reported related research. In a cohort of more than 100,000 PPI users, non-users, and previous users, the PPIs weren’t linked with a higher risk of catching COVID-19 but PPI users experienced “a 79 percent greater risk of severe clinical outcomes of COVID-19,” the journal stated. While the potential risks of PPIs were identified long before COVID-19, the pandemic clearly added to questions.

Finally, Johns Hopkins Medicine reminds people to steer clear of certain foods associated with an acid reaction such as:
  • Fried food
  • Fast food
  • Pizza
  • Potato chips and other processed snacks
  • Chili powder and pepper (white, black, cayenne)
  • Fatty meats such as bacon and sausage
  • Cheese
  • Tomato-based sauces
  • Citrus fruits
  • Chocolate
  • Peppermint
  • Carbonated beverages
Martha Rosenberg is a nationally recognized reporter and author whose work has been cited by the Mayo Clinic Proceedings, Public Library of Science Biology, and National Geographic. Rosenberg’s FDA expose, "Born with a Junk Food Deficiency," established her as a prominent investigative journalist. She has lectured widely at universities throughout the United States and resides in Chicago.


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