In general, PPIs are considered quite safe and for most people who suffer from occasional heartburn symptoms these drugs are the only treatment necessary to control their heartburn. While many, if not most patients remain on these medications for months or even years, it should be pointed out that the manufacturers typically do not recommend them for long-term use in the control of simple heartburn. Other patients with GERD-related symptoms such as chronic cough, asthma, trouble sleeping, regurgitation, laryngitis and even sinus infection may not receive significant benefit from PPIs, since these symptoms often persist even when there is no acid in the stomach. This type of reflux is categorized as LaryngoPharyngeal Reflux (LPR) and is often not affected by acid suppression alone.
These medicines work by stopping the production of acid by the stomach. They are generally extremely effective at reducing or even eliminating heartburn symptoms, but to do so they must be taken on a regular basis.
The overall effectiveness of PPIs often decreases over time, requiring the dosage or the frequency of the medication to be increased. Likewise, some patients switch from one drug to another in order to get the heartburn relief they are seeking. Sometimes the change is the result of insurance that will cover one but not another. Other patients may have trouble taking these medications due to side effects, which can include bloating, abdominal cramps, constipation or diarrhea. Recently these powerful drugs have been identified as being associated with an increased risk of osteoporosis and pathologic fractures due to interference with Calcium and Magnesium absorption by the GI tract. They have also been shown to increase the risk of a common bacterial infection in the colon, called Clostridium difficile, or C.diff.
These medications are widely used to treat a variety of symptoms caused by stomach acid. In the lining of the stomach there are highly specialized cells called parietal cells, which produce highly concentrated hydrochloric acid. Histamine 2 is part of the chemical process that stimulates parietal cells to make acid, and drugs like Tagamet®, Zantac®, Pepcid® and Axid® inhibit that part of the process.
These drugs were first introduced in the mid 1970's, and although they have largely been replaced by the newer and more powerful PPIs (see below) they never-the-less remain an important option in treating GERD symptoms.
Today the most widely used treatment for controlling chronic heartburn and other acid related problem is the class of drugs called Proton Pump Inhibitors (PPIs). If the names sound familiar, it's because they are advertised extensively on television, radio and in print. They include Prilosec®, Prevacid®, AcipHex®, Protonix®, Zegerid®, Dexilant® and of course the little purple pill, Nexium®.