How to Help Acid Reflux Without a PPI – Will Voquezna Be Better?

People with serious acid reflux face a terrible dilemma. To control their uncomfortable symptoms, their doctors prescribe a powerful acid-suppressing drug such as esomeprazole (Nexium), dexlansoprazole (Dexilant), pantoprazole (Protonix) or rabeprazole (AcipHex). These drugs are proton pump inhibitors, or PPIs. Even if a person’s symptoms are not unbearable, they may be told to take a PPI to protect themselves from Barrett’s esophagus or a rare but serious complication, esophageal cancer. But now there is a completely new kind of acid-suppressing drug on the market. Voquezna (vonoprazan) is available only by prescription. Will it become a blockbuster treatment for GERD without a PPI?

A Short History of Acid-Suppressing Drugs:

Older doctors were taught a mantra in medical school: “No Acid…No Ulcer.” The theory goes that Dr. Dragutin (Carl) Schwarz coined that phrase in 1910. He was the primary physician of the surgical department of Charity Brothers’ Hospital in Zagreb, Croatia (Digestive Diseases, Nov. 16, 2011).

For at least a century, most doctors followed Dr. Schwarz’s theory that acid was the culprit behind all ulcers. Doctors were taught that if they prescribed enough acid-neutralizing antacids, they could cure most ulcers.

The ulcer diet restricted spicy food because it was thought to increase acid production. Doctors also warned ulcer patients to avoid citrus fruits, mint, coffee, tea, alcohol and chocolate. There was little evidence to support this “ulcer diet,” yet is has persisted to this day.

When Dr. Barry Marshall suggested that a spiral-shaped germ called Helicobacter pylori caused stomach ulcers, most of his colleagues rejected such an outlandish concept. Ultimately, Dr. Marshall was awarded the Nobel Prize in Physiology or Medicine for this discovery. But old concepts die hard. To this day, many healthcare professionals rely upon acid suppression to cure most ulcers.

Side Effects of PPIs:

Proton pump inhibitors have been racking up serious side effects for the last few decades. When omeprazole (Prilosec) and lansoprazole (Prevacid) were first introduced, doctors believed their side effects were extremely minor. But since then we have learned that people who take a PPI are more likely to break a hip (Annals of Epidemiology, Apr., 2014), suffer diarrhea due to a C diff overgrowth (Expert Review of Clinical Pharmacology, July, 2013), develop chronic kidney disease (JAMA Internal Medicine, Feb., 2016) or have a heart attack (PLoS ONE, June 10, 2015). No wonder many readers have become nervous about taking a PPI.

We now know that suppressing stomach acid can modify the microbiome of the digestive tract. There is also research suggesting that PPIs lead to malabsorption of nutrients such as calcium, magnesium, zinc and vitamin B12.

A study published in the journal Brain Research, Aug. 15, 2025 concludes:

“The increasing incidence of dementia, especially Alzheimer’s disease (AD), warrants careful consideration of possible risk factors, such as prolonged proton pump inhibitor (PPI) use. Although PPIs are extremely effective in controlling acid-related disorders, mounting evidence indicates possible associations between long-term PPI use and neurological effects, including cognitive impairment and dementia.”

Acid-Suppressing Drugs Doctors Have Loved:

When Tagamet (cimetidine) was launched in 1977, it became the first H2 antagonist. This new kind of antihistamine worked primarily in the stomach and was considered a highly effective acid suppressor. It went on to become one of the most successful drugs of its time, with annual sales of greater than $1 billion.  Zantac (ranitidine), another H2 antagonist, followed. It too became a huge best seller.

When Prilosec (omeprazole) was launched in 1989 it took over from the H2 antagonists. The proton pump inhibitors were “stronger” than the H2 antagonists. Doctors loved the new PPIs and they became among the most successful drugs in the pharmacy. When they lost their patents, the drug companies successfully petitioned the FDA to make them available without a prescription.

The New Kid on the Block–Voquezna (vonoprazan):

The latest acid-suppressing drug is Voquezna. It works differently than H2 antagonists or proton pump inhibitors.

A reader recently asked us this question about Voquezna:

Q. I suffer with GERD, and the many meds I have tried do not offer adequate relief. I’ve seen ads for Voquezna. Can you share information on its efficacy, please?

A. Vonoprazan (Voquezna) is the first in a new class of acid-suppressing drugs to be marketed in the US. The FDA approved it for sale in 2024.

Usually, gastroesophageal reflux disorder (GERD) is treated with a proton pump inhibitor (PPI) such as omeprazole, esomeprazole or lansoprazole. These powerful acid-suppressing medications are known by the brand names Prilosec, Nexium and Prevacid.

Voquezna is a “potassium-competitive acid blocker” (PCAB). Some studies indicate that it is at least as effective as a PPI, and it may even be a bit better. A recent review suggests that for someone like you, who have not gotten relief with a PPI, this new acid-blocking drug might be a viable alternative (Cureus, May 17, 2025).

Side effects mentioned in the TV commercial for Voquezna include allergic reactions that may cause:

“trouble breathing, rash, itching and swelling of face, lips, tongue or throat.”

Other serious reactions include:

“kidney problems, intestinal infections, fractures, life-threatening skin reactions, low B12 or magnesium levels and stomach growths.”

Other potential side effects of Voquezna include stomachache, high blood pressure, urinary tract infection, and either diarrhea or constipation.

One other possible obstacle of Voquezna is the price. If insurance does not cover this prescription medication, the coupon price could be as much as $700 for a month’s supply.

You can find more information about this and many other ways to tame heartburn in our eGuide to Overcoming Digestive Disorders. This online resource can be found under the Health eGuides tab at www.PeoplesPharmacy.com.

What About Calcium Carbonate Instead of an H2 Antagonist, PPI or PCAB?

Q. Have any studies been done about the safety of taking calcium for reflux? I take at least four 500 mg generic tablets a day for my GERD. These keep the heartburn under control.

Usually, I take two at bed time so I won’t wake up with a bellyache. I’ve been doing this for years, since I do not want to take a PPI drug like Nexium. Will I regret this?

Calcium Carbonate Antacids Are Best for Short-Term Relief:

A. The calcium carbonate you take is intended for short-term symptomatic relief. Each 500 mg tablet supplies 200 mg of elemental calcium, so four would provide about 800 mg in a day. That is within the recommended dietary allowance of 1000 mg for adult men up to 70 years old. (Women over 50 and men over 70 are advised to get 1200 mg daily; to get this much, most people will need a supplement of some sort.)

What we don’t know is the long-term safety of calcium supplementation. A meta-analysis of 13 double-blind placebo-controlled trials found that women taking calcium supplements were 15 percent more likely to develop cardiovascular disease (Nutrients, Jan. 26, 2021).

In addition, a study published in the journal Gut (March 1, 2018) reported a connection between calcium plus vitamin D supplements and precancerous colon polyps.  The volunteers in this controlled trial were taking 1200 mg of elemental calcium plus 1000 IU of vitamin D3. It took six to ten years for this complication to show up.

In consideration of these risks, you may want to consider other strategies for controlling your heartburn. However, you won’t necessarily need a PPI. You will find lots of options in our eGuide to Overcoming Digestive Disorders.

Resolving a Dilemma:

Q. I have severe acid reflux problems. For treatment, I use Pepcid Complete twice a day. I also use Gaviscon and DGL intermittently, but I worry about whether any of these is a PPI.

Of course, DGL is natural, but would you please settle this once and for all: is Pepcid Complete or Gaviscon considered a PPI?

A. Neither Pepcid Complete nor Gaviscon is a PPI (proton pump inhibitor). PPI drugs such as esomeprazole (Nexium), lansoprazole (Prevacid) or omeprazole (Prilosec) are very effective at healing ulcers and treating gastroesophageal reflux disease (GERD).

Over the past decade, however, scientists have discovered some disturbing side effects from PPIs. The list now includes strokes, heart attacks, kidney damage, dementia, weakened bones and infections.

Gaviscon contains the antacids aluminum hydroxide and magnesium carbonate. Pepcid Complete has three different compounds to help control heartburn: famotidine, calcium carbonate and magnesium hydroxide.

Controlling Reflux without a PPI:

For other strategies to ease indigestion and control heartburn we recommend our eGuide to Digestive Disorders. DGL (deglycyrrhizinated licorice) is a natural compound derived from licorice that can be helpful against heartburn. Other natural favorites for easing heartburn or reflux include ginger-persimmon tea or apple cider vinegar. Over-the-counter approaches include antacids such as Tums or Maalox, or a half-teaspoon of baking soda in a glass of water.

One final word about heartburn. Although the diet that doctors used to recommend prohibited spicy foods, the data remain murky. One diet that appears to be helpful, however, is a low-carb approach.

A small study published 20 years ago in the journal Digestive Diseases and Sciences, Aug, 2006 concluded that:

“These data suggest that a very low-carbohydrate diet in obese individuals with GERD significantly reduces distal esophageal acid exposure and improves symptoms.”

We recently spoke with one of the authors of this study (on July 22, 2025). He confirmed that a very low-carb diet can indeed help ease symptoms of heartburn. Very few healthcare professionals are aware of this research.