One of the many negative side effects of our high-stress, fast-food lifestyle is digestive distress in the form of heartburn or acid reflux, often symptoms of gastro esophageal reflux disease (GERD). Very often, as a result of our fast-paced lifestyle, we instinctively look for a quick fix – usually an over-the-counter drug ranging from calcium carbonate (Tums, Rolaids, etc.) to omeprazole, an effective proton pump inhibitor (PPI) now available without a prescription.
You should know several things before considering self-treatment of GERD. As with nearly all minor ailments, your first choice should be to consider diet and lifestyle changes that could eliminate these symptoms with no negative side effects. Try reducing or eliminating alcohol and caffeine (coffee, sodas, and chocolate) and spicy foods. Eating smaller meals can help, as can losing weight.
If these lifestyle changes don’t take care of the problem, common antacid products or H2 blockers (Pepcid, Zantac, etc.) can often do the job. If your symptoms still don’t improve, proton pump inhibitor (PPI) drugs may be the answer; your doctor can confirm this. PPIs are used to relieve symptoms of GERD, treat a peptic or stomach ulcer, or help repair damage to the lower esophagus caused by acid reflux. These powerful drugs are intended for short-term use only; longer use carries several risks.
In most cases, there is inconclusive proof that PPIs cause serious side effects, but let’s look at the risks associated with long-term use. Anytime the chemical balance in the stomach is changed, there may be consequences. Some nutrients and drugs rely on stomach acid for absorption, and therefore, efficiency. Studies have strongly suggested (but not proven) that PPI use reduces the absorption of calcium, causing an increased risk of bone fracture. Likewise, the effectiveness of blood thinners like clopidogrel (Plavix, etc.) and the anti-osteoporosis medicine alendronate (Fosamax) may be compromised.
PPIs may cause a higher risk of the serious diarrhea condition caused by Clostridium Difficile (C. Diff.) proliferation in a lower acid environment. Some even suspect a higher risk of pneumonia from taking PPIs. The last risk we’ll mention is the least discussed—rebound from abrupt discontinuance of PPIs. Long-term use should be discontinued over a period of time to avoid a spike in stomach acid (rebound effect).
In summary, PPIs, including the less expensive over-the-counter omeprazole (Prilosec and generics) are very effective at treating ulcers and GERD when lifestyle changes and other remedies don’t work. Several risks are associated with long-term PPI use, so as with any drug, the benefits and risks should both be evaluated and validated by a physician.
Sources include: Drugs to treat heartburn, GERD, Consumer Reports, July 2013, Proton-pump inhibitors, Harvard Health Newsletter, April 2011, When Proton Pump Inhibitors Do More Harm Than Good, AARP March 14, 2012