Proton pump inhibitors (PPIs), such as omeprazole and lansoprazole, are the most commonly prescribed drugs in the UK. They are crucial for many, a drug prescribed for a number of conditions including; gastric ulcers, gator-oesophageal reflux disease, as part of h-pylori treatment and prevention and treatment of NSAID induced ulcers.
Proton pumps are enzymes found in the lining of the stomach that aid in food digestion by encouraging acid production. Proton pump inhibitors are activated in the acidic environment of the stomach. They bind to amino acids found in the proton pump thereby inactivating it. This reduces the amount of acid in the stomach.
They are generally considered to be well tolerated with few side effects, the most common being gastrointestinal side effects (constipation, diarrhoea, nausea) or headaches. There have been recent reports that the seemingly harmless drug may have some longer term side effects.
There have been observational studies, that show that those taking PPI’s on a long term basis have an increased risk of fractures. This is due to interference with calcium absorption. Calcium is absorbed from the stomach into the blood and is essential for bone health. However calcium absorption is a pH dependent process meaning that if the pH in the stomach is too acidic or too basic calcium cannot be absorbed.
It has also been hypothesised that PPI’s may be associated with an increased risk of dementia. There have been studies that show PPI’s can affect the absorption of vitamin B12 which is required for cognitive function. This deficiency occurs more in longer term users of PPI’s.
Studies also show that a reduction of acid in the stomach can lead to an increase in bacterial colonisation. This includes bacteria such as C difficile and S pneumoniae both infections that can lead to hospitalisation.
The NICE guidance for GORD involves a holistic approach to treatment, including lifestyle changes such as diet and psychological therapies. They also recommend an approach to treatment “using the effective lowest dose, by trying 'as-needed' (medication) use when appropriate.” Patients who have concerns around the long term effects of PPI’s are recommended to speak to their prescriber before discontinuing any treatment.
Sources
British National Forumlary 2024
Tanus-Santos, J.E. and Pinheiro, L.C. (2019), Proton pump inhibitors: New mechanisms of action. Basic Clin Pharmacol Toxicol, 125: 87-88. https://doi.org/10.1111/bcpt.13237
Lehault WB, Hughes DM. Review of the Long-Term Effects of Proton Pump Inhibitors. Fed Pract. 2017 Feb;34(2):19-23. PMID: 30766253; PMCID: PMC6372031. https://pmc.ncbi.nlm.nih.gov/articles/PMC6372031
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