Quem A Ppis?
PPIs treat conditions that are caused by either an overproduction of stomach acid or exacerbated by stomach acid. Taking a PPI once a day inhibits around 70% of the proton pumps, so a small amount of acid is still available for food digestion.
How quickly do proton pump inhibitors work?
All PPIs work in the same way, by inhibiting the proton pump. However, there are differences in their likelihood of drug interactions, and in the way they bind to the proton pump. This can affect how long they last for.
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Common Side Effects
Proton pump inhibitors reduce the amount of acid made by your stomach. They are commonly used to treat acid reflux and ulcers of the stomach and part of the gut called the duodenum. Most people who take a proton pump inhibitor do not develop any side-effects.
In some people this barrier may have broken down allowing the acid to damage the stomach, causing inflammation or ulceration. In others there may be a problem with the muscular band at the top of the stomach (the sphincter) that keeps the stomach tightly closed. This may allow the acid to escape and irritate the gullet (oesophagus). This is called 'acid reflux' which can cause heartburn and/or inflammation of the gullet (oesophagitis).
Can I buy proton pump inhibitors?
Recent studies have shown that people taking PPIs are at increased risk of gastric cancer (cancer of the stomach). People with gastro-oesophageal reflux are also at increased risk of gastric cancer. Evidence suggests that PPIs reduce the risk of progression to oesophageal cancer in people with Barrett's oesophagus (a condition where the lining of the oesophagus changes and is more at risk of becoming malignant). Evidence also shows that there does not appear to be an increased risk of oesophageal or colorectal cancer with PPIs. The authors of the recent study have suggested that a large, randomised control trial should be set up to confirm or refute their findings that PPIs are associated with a higher risk of gastric cancer. However, in the meantime, the advice for most people (not those with Barrett's oesophagus) would be to only take PPIs as needed and to stop taking them or reduce the dose when they are not needed. People who need long term treatment for heartburn / reflux should also consider whether some of the older treatments (known as H2 blockers) might be sufficient to manage their symptoms.
PPIs have also been associated with an increased risk of bone fractures. Long-term use of higher dose PPIs has been shown to increase the risk of fractures, particularly hip fractures. It is thought that PPIs might reduce the absorption of calcium, thus reducing bone strength.
Richter JE, Vaezi MF. Gastroesophageal reflux disease. In: Feldman M, Friedman LS, Brandt LJ, eds. Sleisenger and Fordtran's Gastrointestinal and Liver Disease. 11th ed. Philadelphia, PA: Elsevier; 2021:chap 46.
Alternative Names
When taking antacids (such as gaviscon or Rennies) it is important to avoid taking them at the same time as other medication including PPIs. This is because antacids can affect how well medication is absorbed.
PPIs stop some of the acid production from cells in the lining of the stomach. This can help to prevent ulcers from forming or assist the healing process. By decreasing the amount of acid, they can also help to reduce acid reflux-related symptoms such as heartburn.
Stopping smoking, losing weight or maintaining a healthy weight, sleeping with the head of the bed raised slightly, eating smaller portions and eating fewer highly-processed foods all help reduce symptoms of GORD and therefore reduce the chances of needing to take PPIs for long periods of time.
How PPIs Help you
PPIs usually work very well to reduce stomach acid and to treat the above conditions. They have significantly improved the quality of life of many people with these conditions since they first became available in the 1980s. They are commonly prescribed.
Omeprazole, lansoprazole, esomeprazole and pantoprazole can be bought over the counter at pharmacies. Rabeprazole still requires a prescription. Medical advice should be sought if requiring a PPI for more than four weeks. Tests such as blood tests, a stool test for helicobacter pylori (a bacteria that lives in the stomach and can cause inflammation and ulceration) or a gastroscopy (a camera passed through the gullet into the stomach) might be needed.
List of Proton pump inhibitors
Over 6 months ago I was very briefly on Omeprazole (20 mg/day). I didn't even have a problem with acid reflux prior to this medication, I was put on it because the doctor thought it might help for...
Many people fail to follow drug label instructions and take PPIs at the onset of symptoms, which may occur after finishing a meal. Taking them in this manner is usually ineffective.
Other considerations when taking a proton pump inhibitor
This can vary depending on the reason for taking a PPI. In some cases a doctor may prescribe a PPI that is taken 'as required' to relieve symptoms rather than every day. In some cases a regular dose taken each day is advised. Some people need PPIs for many years or for life (in conditions such as Barrett's oesophagus); other people will only need them for a few weeks.
PPIs may not be suitable for some people, for example, people with certain liver problems cannot take them. Pregnant people are advised to avoid them unless they are necessary, but there is no evidence of harm from omeprazole or esomeprazole in pregnancy. A full list of individuals who should not take a PPI is included with the information leaflet that comes in the medicine packet.
All the PPIs available in the U.S. are metabolized in the liver by certain liver enzymes (mainly CYP2C19 and 3A4). There is a lot of individual variation in the way these liver enzymes work, and experts have identified three categories of people; extensive metabolizers (homEM), poor metabolizers (PM), and people that sit somewhere in between (hetM).
Types of PPIs
When taken at the recommended dosage for the recommended duration of time, PPIs are considered safe. However, they have been associated with several serious adverse effects including:
Katz PO, Dunbar KB, Schnoll-Sussman FH, Greer KB, Yadlapati R, Spechler SJ. ACG clinical guideline for the diagnosis and management of gastroesophageal reflux disease. Am J Gastroenterol. 2022;117(1):27-56. PMID: 34807007 www.ncbi.nlm.nih.gov/pmc/articles/PMC8754510/.
The stomach produces acid to help with the digestion of food and to kill germs (bacteria). This acid is corrosive so the body produces a natural mucous barrier which protects the lining of the stomach from being worn away (eroded).