George Kevin Gillian, MD, is a board-certified surgeon specializing in treatments for hernia and gastroesophageal reflux disease. He helped to establish the Heartburn Treatment Center at Inova Alexandria Hospital. Read Dr. Gillian’s profile.

If you take proton-pump inhibitors (PPIs) to treat acid reflux or heartburn, you’re not alone. This class of drugs, which includes Prilosec (omeprazole) or Prevacid (lansoprazole), are some of the most widely used medications in the world. Annual sales of PPIs top $11 billion in the U.S. alone.

However, some recent news reports have questioned the safety of taking these drugs long term. Many of my patients are coming to me with questions. Here’s what you should know about PPIs.

Understanding PPIs

PPIs are medications sold by prescription and over-the-counter to treat gastroesophageal reflux disease (GERD), a digestive disorder in which stomach acid flows into the esophagus, causing heartburn.

These drugs are extremely effective, but they were not designed to be taken long term. As more and more people have taken these medications for extended periods, medical experts have identified some causes for concern.

Over the last several years, the U.S. Food and Drug Administration (FDA) has issued several statements of concern related to the long-term use of PPIs. Those concerns include:

  • Low magnesium levels, which are associated with muscle spasms, irregular heartbeat and seizures
  • A possible increased risk of bone fractures of the hip, wrist and spine
  • Possible increased risk of diarrhea associated with the bacterium Clostridium difficile

And although the FDA has not issued an alert on the topic, a 2016 study in the Journal of the American Medical Association reported evidence of a link between PPIs and an increased risk of dementia.

Acid Reflux Treatment Alternatives

It’s important to remember that the overall risk of developing these problems is small. These drugs are relatively safe, and in some cases, the benefit of taking them might outweigh the risks.

Nevertheless, I recommend patients think about the steps they can take to lower the dose (or eliminate the medicine altogether):

  • Get the right diagnosis. First, make sure you actually have acid reflux. Many patients assume they have GERD but instead suffer from another condition, such as an ulcer or an infection of the lining of the esophagus. See your doctor or a specialist to rule out other conditions.
  • Check your dose. Many patients take the maximum dose out of habit. Talk to your doctor to adjust your dose. You might be able to reduce the drug to once a day instead of twice, or even to every other day (using over-the-counter antacid tablets such as Tums in between).
  • Lose weight. Excess weight puts pressure on the abdomen, forcing stomach acid up into the esophagus. Modest weight loss can help reduce symptoms.
  • Eat with care. Skip foods that trigger heartburn, such as fried foods, alcohol and citrus. And avoid eating right before physical activity or before bed, since people often experience acid reflux when they exercise or lay down.
  • Consider surgery. We can often fix GERD with minimally invasive surgery to repair the leaky valve that lets stomach acid flow upward into the esophagus. We can do this either by rebuilding the valve with sutures or by placing a band around the valve to tighten the leak.

If you suffer from GERD, talk to your doctor or learn more about Inova’s heartburn evaluation and treatment options.



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