Long-term Effects of PPI Antacids

Antacids and proton pump inhibitors (PPIs) are common “go-to” remedies for the 50+ million Americans who suffer from chronic gastrointestinal (GI) disorders such as heartburn, acid reflux and gastroesophageal reflux disease (GERD). While these medications (prescription or non-prescription) work to neutralize or decrease the production of acid in the stomach, none should be considered a permanent solution. Symptoms are likely to return shortly after a patient discontinues their use. Moreover, their long-term, unmonitored use can do more harm than good.

If you have been using nonprescription medicines to treat your symptoms for more than two weeks, talk to your doctor.

Antacids are “over the counter” (OTC; nonprescription) oral medications available in liquid, chewable tablet, chewing gum, and dissolving table forms. They are intended for occasional use to relieve symptoms of heartburn and acid reflux by neutralizing stomach acid that backs up into the esophagus. Known by such trade names as Maalox®, Mylanta®, Tums®, Alka-Seltzer® and Rolaids®, antacids may provide immediate, short-term relief, but do not prevent chronic heartburn.

Proton Pump Inhibitors (PPIs) include Prilosec®, Prevacid® and Nexium®, and are the most commonly prescribed medications for treating gastroesophageal reflux disease (GERD). Available as prescription and OTC medicines, PPIs work by reducing the amount of acid in the stomach.

Physicians usually prescribe PPIs when lifestyle adjustments, such as maintaining a healthy weight and avoiding alcohol, cigarettes, and certain foods don’t alleviate the disorder. Despite their popularity, long-term PPI usage has several potential drawbacks, including:

  • Both antacids and PPIs act as a “band-aid” to alleviate symptoms rather than treat the underlying problem. Recent research has shown PPIs are ineffective in controlling GERD symptoms in the majority users.
  • Misuse or overuse of PPIs can result in numerous negative side effects, so it is critical to be routinely re-evaluated by your physician.
  • The Food and Drug Administration (FDA) has issued several warnings related to long-term (a year or more) or high-dose PPI use, including possible increased risk of fractures of the hip, wrist and spine. The FDA advises that PPI users at risk for osteoporosis should have their bone status managed according to current clinical practice, and should take adequate vitamin D and calcium supplementation.
  • Low serum magnesium levels (hypomagnesemia) sometimes can cause muscle spasms; irregular heartbeat and seizures; and potential increased risk of Clostridium difficile infection (CDI, also called C. difficile or C. diff colitis infection). C. difficile are bacteria that can cause severe diarrhea, fever, and abdominal cramps. CDI is especially dangerous to the elderly and immunocompromised. If not treated aggressively, CDI can develop into more serious, even life-threatening conditions, including colitis or sepsis.

While not conclusively proven, other complications that have been associated with long-term and high-dose PPI use include potential cardiovascular events and pneumonia. Some studies have shown that long-term PPI use may reduce absorption of several vital nutrients, vitamins and minerals, as well as hinder the effectiveness of some other medications.

As with all medicines, you and your doctor should weigh the known benefits against the potential risks of PPIs when determining if they are appropriate for you. Always discuss any concerns you have about the medications you are taking with your physician.

The Heartburn and Acid Reflux Center’s board-certified physicians are experts in the diagnosis and treatment of a wide range of GI problems and issues related to long-term PPI use. We’ll work closely with you to devise the optimum treatment plan for your unique circumstances. For more information, call us today at (855) 648-4799.