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Posted on 11-21-2012

acid_reflux.jpgAnother popular class of drug, generating more than $13 billion a year in the United States alone, is the proton pump inhibitor (PPI). These drugs reduce between 90 and 100 percent of acid in the gut by shutting down a system known as the proton pump.

The PPIs, including Prevacid, Nexium, Aciphex and Prilosec, originally were used to manage ulcers, a condition in which acid coursing over open stomach sores caused incapacitating pain. But research later confirmed that most ulcers are caused by the spiral bacteria Helicobacter pylori and could be effectively treated with a brief regimen of antibiotics. Use of PPIs then shifted to common conditions like ordinary heartburn (the burning sensation behind the breastbone) and the far more painful and persistent gastroesophageal reflux disease, or GERD (which results when muscles between the stomach and esophagus stay partly open, allowing stomach acid to leak up, or reflux, into the esophagus, causing pain).

PPIs can, in fact, effectively treat some noninfectious ulcers and severe cases of reflux, but it’s increasingly clear that long-term use can be dangerous, according to a series of studies published last year:

•  Research from the National Institutes of Health, published in Current Gastroenterology Reports, shows that long-term use of PPIs can limit the body’s absorption of essential nutrients, including calcium, magnesium, iron and vitamin B12, which require gastric acid to be absorbed. Risks include not just osteoporosis, but also anemia, fatigue, seizures and cardiac events.

•  The Annals of Internal Medicine reports that long-term use of proton pump inhibitors increases cardiovascular risk for those already suffering myocardial infarction or stroke.

•  The Archives of Internal Medicine reveals that PPIs substantially increase the risk of infection from a particularly hardy bacteria called Clostridium difficile. The study also linked long-term PPI usage with spine, lower arm and total fractures in postmenopausal women. Perhaps even more alarming was the finding that as many as 69 percent of people taking PPIs don’t need them to effectively treat their symptoms.

While almost no one should be using these drugs for years at a time, once someone has been taking them long enough, the habit can be hard to break. It’s been suggested that when patients stop PPIs, a rebound effect increases acid production for a while, causing painful reflux symptoms again. “People should hold out until the excess acid dissipates and the symptoms go away,” says pharmacologist Wright.

Having appropriate levels of acid in the stomach is the healthiest situation of all. Eating high-fiber whole foods (such as beans, veggies and nuts), taking digestive enzymes and probiotic supplements, and decreasing chronic stress can all help to bring your gut back into balance.

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