Many people who suffer from persistent gastroesophageal reflux disease (GERD), and who cannot control their symptoms with lifestyle modifications, turn to drug therapy to alleviate their troublesome symptoms. Although medication may have the ability to control heartburn or other symptoms, relief may only be temporary. Always consult your physician prior to beginning a new treatment regimen.
Types of Drug Therapy
There are three types of medications commonly used to treat GERD: antacids, h2 receptor (H2RAs) and proton pump inhibitors (PPIs). Some brands of these medications are available over the counter (OTC), while others are available by prescription only.
Antacids neutralize gastric acid and may provide rapid but temporary relief. These medications are often available OTC, and are generally safe if they are taken in moderation.
H2 receptor antagonists, (H2RAs) reduce the amount of acid produced in the stomach by inhibiting the release of histamine, the principal stimulus for acid secretion in the stomach.
Proton Pump Inhibitors (PPIs) block the production of stomach acid, which may decrease reflux. PPIs are the most commonly used treatment to treat GERD symptoms. Controlling acid production can help heal esophagitis, which is inflammation of the esophagus caused by repeated exposure to acidic content.
These medications attempt to alleviate symptoms such as heartburn by controlling or reducing acidity in the stomach. The medications outlined above do not impact or address reflux at its root cause, nor do they resolve other symptoms such as frequent regurgitation, difficulty swallowing (or dysphagia), or chronic respiratory problems. Over time, these medications may lose effectiveness, thereby requiring higher doses or more potent alternatives. Consult your physician prior to adjusting your treatment regimen.
Long-Term PPI Use
PPIs are FDA-approved to treat certain gastrointestinal disorders and work by reducing the amount of acid in the stomach. While generally safe and effective for most patients, studies have found that long-term PPI use (>8 weeks) may result in several health complications, including:
- Increased risk of hip-fracture and osteoporosis http://www.ncbi.nlm.nih.gov/pubmed/21605729
- Difficulty absorbing key nutrients, such as magnesium and Vitamin B12, which may lead to deficiencies
- Increased risk of pneumonia http://www.ncbi.nlm.nih.gov/pubmed/21173070
- Increased risk of polyps in the stomach: Long-term PPI use is associated with up to a 4x increase in the risk of fundic gland polyps. http://www.ncbi.nlm.nih.gov/pubmed/17059515
- Reduced gallbladder motility: Short-term PPI therapy reduces gallbladder motility. Chronic PPI therapy may pose a risk for long-term gallbladder dysfunction and biliary complications. http://www.ncbi.nlm.nih.gov/pubmed/16858534
- Increased risk of bacterial gastroenteritis: Regardless of treatment duration, patients currently on PPIs had a 2.9x increased risk of acute bacterial gastroenteritis. Doubling the PPI dose increased the risk to 5x versus patients not on PPIs. http://www.ncbi.nlm.nih.gov/pubmed/18054750
- Increased risk of small intestinal bacterial overgrowth (SIBO): PPIs suppress the gastric acid barrier which can alter the gastrointestinal bacterial population. The prevalence of SIBO, a clinical condition characterized by different degrees of malabsorption, increases after 1 year of chronic PPI use. http://www.ncbi.nlm.nih.gov/pubmed/20060064
It is important to remember that drug therapy only addresses symptom relief, and not the underlying cause GERD. Left untreated, GERD may progress to Barrett’s esophagus, which is a change in the lining of the esophagus and is considered a pre-cancerous condition.
If you are concerned about the possible adverse effects of long-term PPI use, consult your physician or gastroenterologist about your options, which may include the Medigus Ultrasonic Surgical Endostapler (MUSE™), an incisionless procedure for the long-term treatment of persistent GERD.