Treatment with proton pump inhibitors (PPIs) for eight weeks induces acid-related symptoms like heartburn, acid regurgitation and dyspepsia once treatment is withdrawn in healthy individuals, according to a new study in Gastroenterology, the official journal of the American Gastroenterological Association (AGA) Institute.
Went through my fair share of heartburn woes at the end of my undergraduate. Took a few different PPIs for acid reflux. Acid reflux, to wit, is chronic heartburn. It can be caused by poor diet, stress, or something mechanically wrong with your esophagus.
If it’s one of the first two, then eventually, you should be able to stop taking them with a change in diet and lifestyle. If your stomach is just mechanically predisposed to spewing acid, then it will probably be a more longterm thing. I don’t know if there’s a downside to long term use of PPIs, but there’s a big downside to long term severe acid reflux: ulcers and various nasty forms of cancers. So even if prevacid has side effects, I suspect that they would be outweighed by the benefits.
Well, no medication should be taken if there’s no good reason to do so. In other words, do the benefits outweigh the risks?
PPIs have a big benefits. They are (justifiably) the gold standard for treatment of severe reflux, acid peptic disease, etc. (along with H. Pylori eradication when warranted). Risks? Maybe. There is some evidence that they increase your risk for C. diff colitis (a BAD disease). Likewise, there is some, far less convincing, data to suggest they may promote pneumonia and osteoporosis (with long term use). But all meds have risks. Again, the question is do the real benefits outweigh the real and theoretical risks.
The study you cite is one year old. AFAIK, there’s not been a lot of excitement about it. Perhaps it was because the study was done on normal volunteers, i.e. without problems like heartburn and ulcers. With respect to my question above, these volunteers had no potential benefit, only risks. Moreover, they seem to be the wrong group to study. Why study people who will not be prescribed PPIs? What counts is the effect on people who should, and do, get prescribed PPIs, i.e. people with reflux and ulcers etc.
Some of the study’s results were of borderline statistical significance. This is an important caveat when so many different statistical comparisons have been done (i.e. was statistical allowance made for such multiple testing, such as a Bonferoni correction?). Most significantly, the actual numbers show a fairly small effect; typical differences were values like 23 percent in PPI treated patients and 7 percent in controls - an absolute difference of around 15 percent, i.e. about 1 in 6 or 7 people. Phrased differently, 5 out of 6 or 6 out of 7 had no ill effect from the PPIs. And what were these effects? Big deal things like ulcers or bleeding? No, subjective outcomes only - in other words, just symptoms. Not irrelevant, but a surrogate for what really counts, i.e. objective outcomes like documented ulcers and the like.
True, but it begs the question that normal people will have the same responses as do people who have the condition for which the drug will be actually prescribed IRL. That’s especially relevant when you’re talking about rebound acid secretion (where people suffering from the effects of ‘too much’ acid at square one may respond differently than those who don’t have such symptoms and/or don’t have ‘too much’ acid - for example, maybe people with symptoms from acid may be especially prone to rebound hypersecretion; then again, maybe they’re already max’d out and can’t get any worse, even after stopping a drug that causes rebound acid secretion in normals).
In terms of ‘most’ drugs having some withdrawal syndrome or at least symptoms, if they do, the phenomenon is clinically silent, i.e. most drugs have no detectable withdrawal syndrome. But your point is well taken - a LOT of drugs do (narcotics, steroids, beta blockers, nitrates, clonidine, venlafaxine (Effexor), L-dopa, and possibly aspirin and warfarin (coumadin), and more I’m sure )
Anecdotes != data, obviously, but I’ve heard people note that when they discontinue or decrease their PPIs, they have some degree of “rebound”, acid-wise, as they do so; they can get past this by tapering slowly and using regular antacids as needed.
Recent personal experience: In January, I was taking 1 Prilosec OTC (20 mg) per day) and getting pretty decent control of that burning feeling.
Doc instructed me to bump that up to twice a day (due to some apparent GERD-related nighttime coughing). I did so for a month or more.
A month ago, for various reasons, I needed to push back a number of medications to pre-January levels. I skipped that morning Prilosec and by that afternoon was experiencing heartburn symptoms where 2 months before, with no morning dose, I’d have been fine.
Whether that was rebound, or a worsening of the GERD issues which we’re still dealing with, I don’t know. I started back on the morning dose the next morning so I didn’t see whether things would resolve without it.
I’ve suffered from an Esophageal restriction for years. I had the balloon expansion treatment which didn’t work, so I went on Aciphex for about a year. After I lost my job and health insurance, I could no longer afford the Aciphex, so I switched to generic Prilosec. I asked my Dr. about it for long term, and he told me it was OK as long as it worked. I can tell you that yes, it does have a nasty rebound. If I’m not able to take it daily, the heartburn starts within 24 hours and the Esophageal restriction will begin to return within 48 hours. Not pretty, but better than choking, trying to force down every bite of food with a huge gulp of water (painful). I’ll be a total mess if I’m not able to get my meds for this and blood pressure…
Well yikes. I have been taking Prilosec almost every day (probably around 4 days a week) for almost two years now. Two of my doctors know and haven’t said I should stop. I get acid reflux from many things and work out a lot, and if I don’t take Prilosec I have horrible reflux after exercising (that seems to stir it up).
I know of a few foods that give me terrible heartburn–coffee, any citrus juice or fruit, any kind of healthy spread such as Smart Balance (but not actual butter), some cereals–but it is difficult to avoid all of them, so Prilosec it is.
I’ve come across H Pylori and its association with stomach issues. I haven’t been able to tell if it’s legit science or quackery. Like if I ask my doctor about it, is she going to laugh at me?
A previous doc told me to take prilosec every day. I didn’t question it. I switched to pepcid later and actually eventually weaned myself off it. There was a GQ thread a while back and there I posted how I started on probiotics and that seemed to get a lot of my reflux under control. When I stopped my probiotics, my reflux came back with a vengeance and I’m still flaring up pretty often even though I’m back on the probiotics.
I can’t avoid my trigger foods very well. Sometimes it’s when I have a little of a lot of my triggers. Sometimes it’s when I have a lot of one of my triggers. Sometimes it’s got nothing to do with anything I can figure. Water actually gives me heartburn often.
H. Pylori is pretty definitely proved to be the cause of peptic ulcers. All that old stuff about stress, food, or whatever causing ulcers is a big load of crap. The 2005 Nobel Prize in medicine was awarded for this discovery. So if your doctor laughs at you, you need to get a new doctor, because your doctor is woefully out of date. At this point, that would be the equivalent of saying that malaria is caused by poor ventilation and swamp gases.
It’s taught in nursing school, so it’s not considered quackery at this point. Trouble is, lots of people have h. pylori and no ulcers, and some have ulcers and no detectable h. pylori. But in the ones who do have ulcers AND h. pylori, getting rid of the h. pylori seems to help get rid of the ulcers.
…so it’s all sort of a “we dunno” thing. There does seem to be some connection, but it’s not as concrete as saying that h. pylori causes stomach ulcers - sometimes it does, sometimes it doesn’t, sometimes ulcers happen without it. But it’s certainly a test you want to have if you do have ulcers, and no reputable doctor will laugh at you for bringing it up.
Just to add that if someone has an ulcer and is H. pylori positive, then even if they get total relief and endoscopically documented healing of their ulcer by the use of acid suppressive therapy, the ulcer will probably recur if the H. pylori is not also treated (i.e. eradicated by antibiotic treatment). One early study showed an 85 percent ulcer recurrence rate if H. pylori is not eradicated versus 2 percent if it is eradicated. Pretty convincing numbers.
Not everyone chronically infected with Neisseria meningitidis has ever had meningitis, but we still say that N. mengitidis causes outbreaks of bacterial meningitis. Yes, host response does play a major role in whether you will get sick from a variety of pathogens, but it’s still accurate to say that the pathogen causes the disease, IMO. Yes, I know Koch’s postulates, and I think strict adherence to them is outdated in the face of what we know now about the complexity of host-pathogen interactions.
Another factor in any discussion of digestive issues is that contrary to popular belief, gastroenterology is by no means an exact science. Your doctors always sound very confident when they’re talking to you about your problems, but after years of, “Well, let’s try this and see how it goes,” I know better now.
My wife has a hiatal hernia and acid reflux and has been taking losec (the name used in Canada) for years and has had no ill effects. She has never tried going off it, but still gets an occasional attack (red wine on an empty stomach will do it every time). It has really improved her quality of life.
