8 Medications Treatment To Acid Reflux - 4
6. Proton-Pump Inhibitors
Proton-pump inhibitors (PPIs) suppress the production of stomach acid and work by inhibiting the molecule in the stomach glands that is responsible for acid secretion, which is called the gastric acid pump. The standard agent has been omeprazole (Prilosec) which is now available over-the-counter without a prescription. Newer prescription oral PPIs include esomeprazole (Nexium), lansoprazole (Prevacid), rabeprazole (Aciphex), and pantoprazole (Protonix).
Studies report significant relief from PPIs in most patients with heartburn. PPIs are effective for healing erosive esophagitis and may also be helpful in patients with chronic laryngitis that is suspected to be caused by GERD. The newer agents provide quicker symptom relief compared to omeprazole. However, a 2002 comparison study suggested that to date esomeprazole (Nexium) is the only newer oral PPI to show any significant advantage over omeprazole (Prilosec). In any case all PPIs are more effective than the H2 blockers.
In addition to relieving most common symptoms, including heartburn, proton-pump inhibitors also have the following advantages :
- They are effective in relieving chest pain and laryngitis caused by GERD.
- They may also reduce acid reflux that typically occurs during strenuous exercise.
Patients with impaired esophageal muscular action are still likely to experience acid breakthrough and reflux at night. Proton-pump inhibitors also may have little or no effect on regurgitation or asthmatic symptoms. Some experts believe, however, that they should be the first drugs of choice even for patients with milder symptoms. At this time, these drugs are recommended for the following patients :
- Those with moderate symptoms that do not respond to H2 blockers.
- Those with severe symptoms.
- Those who have respiratory complications.
- Those who have persistent nausea.
- Those who have esophageal injury.
These agents have no affect against non-acid reflux, such as bile back-up. Adverse Effects. Proton-pump inhibitors may pose the following concerns :
- Side effects are uncommon but may include headache, diarrhea, constipation, nausea, and itching.
- Proton-pump inhibitors should be avoided by pregnant women and nursing mothers, although recent studies suggest that they do not pose an increased risk of birth defects.
- They may interact with certain drugs, such as antiseizure agents (e.g., phenytoin), anti-anxiety drugs (e.g., diazepam), and blood thinners (e.g., warfarin).
- Long-term use of high-dose PPIs may produce vitamin B12 deficiencies, but studies are needed to confirm any significance of this risk.
There is some evidence that acid reflux may contribute to the higher risk of cancer in BE, but it is not known yet if acid-blockers have any protective effects against cancer in these patients. In fact, the long-term use of proton-pump inhibitors by people with H. pylori may, in theory at least, reduce acid secretion enough to cause atrophic gastritis (chronic inflammation of the stomach). This condition, in turn, is a risk factor for stomach cancer. To compound concerns, long-term use of PPIs may mask symptoms of stomach cancer and so delay a diagnosis. To date, however, there have been no reports of an increased risk of stomach cancer with long-term use of these drugs.