In the near future, a patient may be more likely to be prescribed a PPI for two to four weeks and then taken off it, says Pichetshote. The days of a doctor prescribing a lifetime of PPI use could be coming to an end. Cleveland Clinic. It can be hard to pin down because it often masquerades as something else or has no obvious or consistent symptoms.
If a patient has refractory GERD, there will be evidence on endoscopy (erosive esophagitis or Barrett’s esophagus). However, if nothing is found on endoscopy, the patient should have pH monitoring to prove that the symptoms correlate with episodes of reflux and expected drops in esophageal pH. In patients who remain symptomatic despite PPIs, functional oesophageal tests provide a useful objective measure of oesophageal function after exclusion of any structural lesion or cardiac cause.
Additional testing, such as an upper endoscopy, may also be needed. Another test is reflux monitoring. One such test uses a thin probe through the nose and esophagus that’s connected to an external data recorder and measures acid and non-acid reflux into the esophagus. The patient keeps a diary of symptoms while the recorder measures the amount of reflux. Dietary modifications and lifestyle measures are useful for GERD patients.
A bundle of muscles at the end of the esophagus, called the lower esophageal sphincter (LES), keeps your stomach contents from traveling up into your esophagus as acid reflux. Aside from swallowing and burping, the LES remains closed. However, if you’re experiencing changes in your IAP, the sphincter relaxes and opens at inappropriate times. That allows GERD to become a problem. As compared with the H2 blocker group, people in the PPI group were older (64 years old, on average, versus 61) and also somewhat sicker, with higher rates of diabetes, hypertension and cardiovascular disease.
Side effects of proton pump inhibitors and Zantac that are similar include constipation, diarrhea, headache, nausea, and vomiting. In the last few years, researchers have been able to evaluate the side effects and complications of medications by using large databases of millions of patients. In the 1980’s there were concerns that, by profoundly decreasing stomach acid production, they might lead to other health problems such as serious infections, poor absorption of vitamins and minerals, even gastrointestinal cancers. However, by the mid-1990s, based largely on anecdotal experience, it was becoming clear that PPIs were remarkably safe. Interestingly, the incidence of
When Should a Patient with GERD Be Referred for Surgery?
If you have concerns about PPI use, talk to your healthcare provider. In my case, (work induced) stress was an exacerbater of acidity. As the stress decreased (I took early retirement.), so did my raging heartburn but te cough increased.
Oesophageal manometry is an important diagnostic tool to exclude achalasia(34,35) as well as other major motility disorders, including oesophageal spasm, aperistalsis and hypercontractile oesophagus.(36) Ambulatory 24- or 48-hour oesophageal pH studies or 24-hour combined pH-impedance studies are well-described diagnostic modalities used by gastroenterologists to confirm or exclude GERD as a cause of persistent symptoms. This would avoid the unnecessary use of PPIs when there is no objective evidence of GERD.
PPIs are more effective than H2RAs for the short-term (14 days) treatment of symptoms of GERD, with the clinical effect of short-term PPI lasting up to 10 weeks. (bariatric weight loss surgery has variable effects on GERD. Gastric bypass and gastric banding surgery has been shown to improve GERD symptoms; however, GERD can return within a few years of gastric banding. Gastric sleeve surgery can potentially precipitate GERD in people without preexisting symptoms).
Recently the FDA has issued several warnings concerning the long-term risks of PPIs, including bone fractures and even life-threatening infections. (16, 17, 18) New research articles pop up every few weeks with evidence linking PPIs to various health problems. I could write a whole book on the subject. But, as I want this article to focus on how to avoid PPIs altogether, I’ll only focus on some of the risks associated with acid-suppressing medications.
Proton pump inhibitors (PPI) medicines review. Consumer Reports Best Buy Drugs. July 2013. www.consumerreports.org/cro/2013/07/best-drugs-to-treat-heartburn-and-gerd/index.htm. Accessed June 22, 2017.