Risks and Rewards with Acid Reflux Medications

If you're one of the 60 million Americans suffering from acid reflux (a.k.a. heartburn), chances are you take one or a combination of medications to treat your symptoms. With the expanded availability of different types of products, consumers may not know the difference from one medication to the next. The history, evolution, and availability of heartburn medications have changed dramatically over the past 20 years adding to the complexities associated with choosing the right medications to fit your needs. One class of heartburn mediations, known as Proton Pump Inhibitors (PPI), have been available since the late 1980's – early 1990s and have been the primary staple in treating conditions such as peptic ulcer disease, gastroesophageal reflux disease (GERD), and indigestion. Most people know PPI medication by their trade names, which include Protonix, Prilosec, Prevacid, and Nexium as the more common drugs on the market. The price of PPI's has decreased, now offering more affordable and available generic or over-the-counter options. Prior to PPI's, less powerful drugs were utilized, particularly H2-receptor antagonists, such as Zantac, Pepcid, and Tagamet. At the time, H2-receptor antagonists were considered revolutionary and offered relief without the chronic need of popping Tums and chugging Pepto-Bismol like a college senior floating a keg. But, over time, PPI's became more widely used over H2-receptor antagonists due to their efficacy in treating gastrointestinal disorders.

However, all medications carry the reward of symptom relief at the expense of certain side effects. PPI's are no different and those who take these medications should be aware of the potential risks. Aside from the omnipresent side effects (headache, nausea, diarrhea, vomiting, gas, constipations, etc) found with virtually every medication, a few associated with PPI have begun to stand out in recent years. In May of 2010, the U.S. Food and Drug Administration (FDA) warned about the possible increased risk of fractures associated with long-term PPI use. In March of 2011, the FDA released an additional warning on PPI use, of greater than one year, may cause low magnesium levels. Other known risks include vitamin B-12 deficiency and an increased possibility of developing intestinal infections from a certain bacteria known as clostridium difficile.

PPI's reduce the amount of stomach acid by altering the process of acid production in the body. Although this reduction of stomach acid may solve a variety of problems, many feel it is the common factor attributed to the negative side effects mentioned. Stomach acid plays a key role in the digestion process, including the absorption of nutrients, vitamins, and minerals. For instance, Vitamin B-12, most commonly consumed when eating animal protein such as beef, relies on stomach acid to be broken down for absorption into the body. Symptoms of vitamin B-12 deficiency include weakness, memory problems, poor balance, anemia, and soreness of the tongue and mouth.  Natural intestinal flora, otherwise known as "good bacteria", can also be disrupted when the pH levels shift. A change is the intestines pH allows for an environment conducive for clostridium difficile growth, which can cause symptoms ranging from diarrhea to life-threatening inflammation of the colon. Also, medications such as digoxin and diuretics can deplete magnesium levels. If you are taking a PPI along with these medications, this increases your risks further.

Do keep in mind; these side effects are less common than the benefits PPI's afford patients. However, incorporating the following strategies will allay potential issues down the road:

• Talk to your doctor about long term use of PPI's
• It is recommended to take the lowest dose possible to achieve the desired results
• Routine lab work is beneficial to monitor vitamin B-12 and magnesium levels
• If necessary, your doctor may prescribe vitamin B-12 and/or magnesium supplements
• Diagnostic tests, such as a non-invasive bone density scan can help determine if bones are weak or becoming fragile
• Review with your doctor, every medication you take (including over the counter and any herbal, homeopathic medications) to determine if any interactions may exist with concurrent use of a PPI
• Lifestyle modification, including proper diet and exercise, may help you reduce your dosage needs or eliminate the use of PPI's altogether