Proton pump inhibitors (PPI for proton pump inhibitors) are stomach-protecting medications. They used to require a prescription, but now PPIs with the active ingredients pantoprazole and omeprazole are available over the counter in pharmacies for self-medication of heartburn and acid regurgitation. In about 30 percent of the population, stomach acid flows back into the esophagus (reflux). However, the acidic gastric juice irritates their unprotected mucous membrane. It becomes inflamed and damaged. In extreme cases, esophageal cancer can even develop. Therefore, this gastric acid reflux into the esophagus must be prevented or at least reduced as far as possible.
Stress and high-fat foods as significant factors
Heartburn can be caused by a slack sphincter at the entrance to the stomach or a large gap in the diaphragm. Sometimes, too much stomach acid is produced. Stress and diets high in sugar and fat play a role here. However, proton pump inhibitors are not only used to treat heartburn and prevent inflammation in the esophagus, but also to treat and prevent duodenal or gastric ulcers and as part of a combination therapy against the stomach germ Helicobacter pylori.
How do proton pump inhibitors work?
Stomach acid is produced in the so-called pouch cells of the stomach. Agents such as omeprazole and pantoprazole suppress (up to 100 percent, depending on the dose) the production of stomach acid by inhibiting a specific enzyme (H+/K+-ATPase), namely a so-called “proton pump” in the vestibular cells until the cells regenerate again. Hence the name proton pump inhibitor. The active ingredient is absorbed through the intestine. By inhibiting the mini-pumps, hydrochloric acid production in the stomach is reduced and the acidity of the gastric juice decreases. Therefore, it is no longer as “aggressive” and any mucosal inflammation or injury heals more quickly during four to eight weeks of PPI therapy.
Proton pump inhibitors: side effects
Proton pump inhibitors are considered effective and well tolerated when taken for short periods of time, but side effects can still occur. Common side effects of proton pump inhibitors include:
- Gastrointestinal disturbances (diarrhea, constipation, stomach pain, nausea, flatulence).
- Headache
- Fatigue, sleep disturbances, dizziness
In rare cases, visual, hearing and taste disorders, kidney inflammation and elevated liver enzymes and blood count changes occur. PPIs are suspected of promoting the development of food allergies and, especially at higher doses, the colonization of the stomach with bacteria. In addition, there is evidence that proton pump inhibitors may promote osteoporosis. High-dose use of proton pump inhibitors increases the risk of femoral neck fractures twofold. Furthermore, long-term use of gastroprotective drugs can cause chronic gastritis to develop and the stomach to produce too much gastric acid after the drug is discontinued. This can result in PPI dependence. A large-scale study from Germany involving approximately 73,000 subjects also suggests a link between long-term use of proton pump inhibitors and an increased risk of developing some form of dementia.
Proper dosage and use
Omeprazole and pantoprazole are approved in adults for short-term treatment of heartburn and acid regurgitation. Children, pregnant women, and breastfeeding women are excluded. The recommended daily dose for self-medication is one enteric-coated tablet (20 milligrams) that should not be chewed or crushed. When dosed as directed, the vital functions of gastric acid are maintained. However, the doctor may advise a higher dose depending on the type and severity of the condition. Proton pump inhibitors should not be swallowed for longer than four weeks without medical clarification, especially when taken for heartburn. If symptoms do not improve within two weeks after taking PPIs, a visit to the doctor is also highly advisable. There are also affected individuals who do not respond or respond inadequately to PPI.
Discontinuing proton pump inhibitors
PPIs should only be discontinued in consultation with a physician. This person can best decide on a proper and gentle course of action. If one wants to discontinue proton pump inhibitors, this is usually done gradually because of the side effects mentioned above.Thus, the dose can initially be lowered or the frequency of intake reduced. However, tablets or capsules should not be crushed in the process. This destroys the acid-stable coating of the medication, which means that the active ingredient can no longer be absorbed through the intestine, but dissolves in the stomach. Alternatively, therefore, medications with lower doses of active ingredient can be taken.
Alternative treatment options
As an alternative treatment to proton pump inhibitors, the active ingredient alginate has been under discussion for several years. This neutralizes acid and forms a viscous gel when in contact with stomach acid. Home remedies and a change in eating habits can also help, at least with mild heartburn. Milk or cottage cheese, as well as still water or teas, dilute stomach acid and can at least lessen its effect. Coffee, alcohol or spicy food, on the other hand, have a counterproductive effect on heartburn. You can find more tips against heartburn here.
