Every once in a while you may feel stomach upset after having a good ol’ buffet, and that discomfort can often be relieved by taking Gaviscon® you purchased from the nearest pharmacy. However, for many people they may experience more serious gastric issues that urge them to see a doctor. It is likely that doctors may prescribe them a gastric medication from a drug class known as the proton-pump inhibitors, or PPI for short.
Know your gastric medications
Medications such as Gaviscon® are gastric medications belonging to another drug class known as the antacids. Antacids contain hydroxide salts that neutralises the excess gastric acid in your stomach, thus providing relief to your gastric discomfort. Many improved formulas of antacids, including Gaviscon®, also contain sodium alginate, which creates a “raft” that floats on top of the gastric content in your stomach. This may help to relieve reflux symptoms in the event of gastroesophageal intestinal reflux disease (GERD).
On the other hand, PPI relieves gastric pain by effectively blocking your gastric acid secretion. It is prescribed to patients with a wide range of digestive issues, including GERD, indigestion/heartburn, ulcers in stomach or small intestine, as well as patients receiving H.pylori infection treatment. In some cases, if a patient is taking other medications that may cause gastric ulcers, such as aspirin (for prevention of heart attack), then the doctor may prescribe PPI to prevent the patient from developing gastric issues.
In Malaysia, the commonly used PPI include omeprazole (Losec®), esomeprazole (Nexium®), dexlansoprazole (Dexilant®) and pantoprazole (Controloc®).
Simply put, antacids work by treating the symptoms while PPI works by addressing the underlying causes that provoke your gastric pain. PPI is more effective than antacids at relieving many of the gastric conditions mentioned above.
(Note: This is in no way saying that you should always take PPI whenever you have gastric issues. Your doctor would make the diagnosis and recommends the appropriate gastric medications to you. Also, PPI is classified as a prescription medication in Malaysia, hence you won’t be able to buy it without a doctor’s prescription.)
Taking PPI for long-term
People take PPI for variable duration, some take it for a short period of time for relieving symptoms, whereas some are required to take it for months for more serious gastric problems.
Before we dive into the health risks of taking PPI long-term, it is worth knowing that PPI is widely studied by scientists and is considered generally safe to take. But it is not without its health risks, especially if your doctor advises you to take PPI long-term. Here are some of the health risks associated with taking PPI for an extended period of time.
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Gastrointestinal infection with Clostridium difficile (C.difficile)
Image credit: https://www.cdc.gov/hai/organisms/cdiff/cdiff_infect.html
In 2017, the United States Food and Drug Administration (FDA) issued a safety announcement on PPI, advising that patients should immediately contact their healthcare professional and seek care if they take PPI and develop diarrhea that does not improve. This is because a profuse and serious diarrhea may imply C.difficile infection, which its odds is significantly raised by long-term use of PPI. The underlying mechanism is yet to be understood by the scientists. A gastrointestinal infection of C.difficile is even more likely if you are an elderly who is taking PPI and antibiotics.
If you experience symptoms such as watery stool, abdominal pain and fever during a long-term treatment of PPI, seek medical help immediately.
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Bone fractures
Taking PPI long-term may lead to low levels of gastric acid (clinically known as hypochlorhydria), an accompanying health risk is augmented bone break down, which may lead to lower bone density and thus a higher bone fracture risk. The risk is even higher among the elderly, those with existing osteoporosis, postmenopausal women and those who smoke.
Although more studies are required to look into the relationship between taking PPI long-term and bone fracture risk, scientists postulate that it may have been due to the lower absorption of calcium. Typical calcium absorption is significantly reduced when the stomach is less acidic. This can be easily overcome by taking calcium citrate supplement. Unlike other calcium supplement formulations, calcium citrate particularly does not require an acidic environment for its absorption.
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Disturbance in levels of magnesium in your blood
Although rare, taking PPI long-term can lead to low levels of magnesium in your blood, which may be life-threatening. Symptoms of low level of magnesium include muscle weakness and cramp, convulsion, irregular heartbeat, and low blood pressure. Study found that most cases occurred after taking PPI for 5 or more years. The risk can be even greater if you are also taking medications that can further lower magnesium level, such as digoxin and diuretics.
If you suspect yourself to experience low levels of magnesium due to taking PPI long-term, see your doctor for further discussion.
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Worsening of symptoms once PPI is stopped
In some cases, after stopping PPI, you may experience even worse gastric symptoms than ever before. This may be due to a condition known as hypergastrinemia, a long-term gastric acid suppression that ultimately leads to a rebound hyperacidity. Research even found that taking PPI for as short as 8 weeks, or 2 months, may also subject patients to hypergastrinemia. This can be avoided by slowly reducing the amount of PPI instead of stopping it abruptly. Discuss the best ways to exit your PPI treatment plan with your doctor.
So, what now?
If your doctor advises you to take PPI, it perhaps because the benefits of a PPI treatment you may receive outweighs the health risks mentioned above. If you are worried about these risks nonetheless, always speak to your doctor. Do not stop taking PPI without consulting your healthcare provider.
References:
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https://www.uspharmacist.com/article/proton-pump-inhibitors-considerations-with-longterm-use
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https://www.uspharmacist.com/article/appropriate-use-and-safety-concerns-of-proton-pump-inhibitors
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