HAVE YOU BEEN ON A PPI TOO LONG?

Are you taking a class of drug known as a PPI, or proton pump inhibitor? When this type of medication was introduced nearly 25 years ago, it was predicted to be a “miracle drug” and a pill capable of transforming the lives of millions. And, for many people, PPIs have been transformative. However, not everyone who takes a PPI should be on one or, at least, on one for an extended period of time.

The benefits certainly outweigh the risks, but why not avoid the risks if you can and seek the care of board-certified gastroenterologist  for a thorough evaluation?

If you have been on a PPI for more than eight weeks and are not currently under the care of a gastroenterologist, it’s time to take another step in taking control of your health: contact a gastroenterologist near you. A gastroenterologist is specially trained in the assessment and evaluation of the gastrointestinal system and can help you determine if alternative treatment options will be more effective for your condition.


Best Practices for PPI Use

In March 2017, the journal Gastroenterology  published a review evaluating the risks and benefits of long-term PPI use. The review offered physicians and patients a few tips for assessing PPI use:

  • Patients with GERD and acid-related complications, such as erosive esophagitis or peptic stricture should take a PPI for short-term healing, maintenance of healing, and long-term symptom control.
  • 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 before committing to lifelong PPIs to help    distinguish GERD from a functional syndrome.
  • Patients with Barrett’s esophagus and symptomatic GERD should take a long-term PPI.
  • Asymptomatic patients with Barrett’s esophagus should consider a long-term PPI
  • Patients at high risk for ulcer-related bleeding from NSAIDs should take a PPI if they continue to take NSAIDs.
  • The dose of long-term PPIs should be periodically reevaluated so that the lowest effective PPI dose can be prescribed to manage the condition.
  • Long-term PPI users should not routinely use probiotics to prevent infection.
  • Long-term PPI users should not routinely raise their intake of calcium, vitamin B12, or magnesium beyond the Recommended Dietary Allowance (RDA).

If you are on a PPI or considering a PPI as part of your treatment plan, talk to a gastroenterologist. A GI doctor will be able to provide a thorough and expert evaluation.


References:

Freedberg, D., Kim, L. and Yang, Y. (2017). The Risks and Benefits of Long-term Use of Proton Pump Inhibitors: Expert Review and Best Practice Advice From the American Gastroenterological Association. Gastroenterology, 152(4), pp.706-715.

Scarpignato, C., Gatta, L., Zullo, A. and Blandizzi, C. (2016). Effective and safe proton pump inhibitor therapy in acid-related diseases – A position paper addressing benefits and potential harms of acid suppression. BMC Medicine,