Barrett’s Oesophagus: PPI making reflux/acid worse

Surgical fundoplication for GERD is still performed but the rate of utilization has been markedly decreasing in recent years. Endoluminal therapies provide an efficacious symptomatic control in a subset of patients and serve as a good alternative to medical or surgical treatment. Overall, the risk of any of the aforementioned side effects due to long-term treatment with a PPI is relatively modest. Because almost all of the studies reporting these side effects are population based, it is unclear if any of the aforementioned retrospective reports will be confirmed in a prospective trial.

That’s the opposite of what we would expect if excess stomach acid were to blame for the problem. Up to 40 percent of U.S. adults experience symptoms of gastroesophageal reflux disease (GERD) once a month, and approximately 10 percent of the adult population takes a proton pump inhibitor (PPI) for this condition.

Therapy should not be withheld from patients with pulmonary disease if indicated. It is important to ensure that patients who are at risk for CAP, including the immunocompromised, elderly, smokers, and those with COPD and asthma, receive their annual influenza and recommended pneumococcal vaccinations.

Why PPIs are a Poor Silent Reflux Treatment

Studies have shown that PPIs can cause reflux symptoms in people who didn’t have them before, when they tried to quit them. This can heighten GERD symptoms and lead people to reach for their meds again, leading to long-term use. Proton pump inhibitors (PPIs) are one type of medication that can be used to reduce stomach acid and relieve GERD symptoms. Other medications that can treat excess stomach acid include H2 receptor blockers, such as famotidine (Pepcid AC) and cimetidine (Tagamet). However, PPIs are usually more effective than H2 receptor blockers and can ease symptoms in the majority of people who have GERD.

Like most medications, there are side-effects and complications. Fortunately the overall risk of long-term PPI use still seems to be relatively small. There have been other reports over the past couple of years about the possible risk of pneumonia and infections of the colon with a bacterium called clostridium difficile in patients taking PPIs.

Nonetheless, failure to satisfactorily resolve potential GERD symptoms has become one of the most common reasons for gastroenterological consultations in the US and Western Europe [5]. This treatise will explore the many facets of this clinical scenario and propose a systematic approach to management. Many health professionals believe that because deficiencies are relatively rare, they are not worth worrying about due to the health “benefits” of PPIs.

PPIs Might Help In Special Cases

PPIs interact with some common prescription drugs. For example, some PPIs can reduce the blood-thinning effect of the drug Plavix (generic clopidogrel). This can increase the risk of heart attack and even death. Before taking any antacids or PPIs, you should talk to your healthcare provider.

PPI plus prokinetics

These same factors have also contributed to their overuse and misuse; healthcare providers are often prescribing these agents for prolonged-even lifetime-use, and many patients are taking the OTC agents beyond the recommended course of therapy without any supervision. A recent report in the Journal of the American Medical Association (JAMA) looked at the medical records of over 9 million people in the United Kingdom. They were able to identify over 13,000 people with a hip fracture and compare them to over 135,000 people who did not have a hip fracture. They found that using a PPI for over 1 year increased the risk of a hip fracture by 44%.

But antacids alone won’t heal an inflamed esophagus damaged by stomach acid. Overuse of some antacids can cause side effects, such as diarrhea or sometimes kidney problems. Surgery for GERD may involve a procedure to reinforce the lower esophageal sphincter called Nissen fundoplication. In this procedure, the surgeon wraps the top of the stomach around the lower esophagus.

gerd worsening with ppi

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