Man with Heartburn

Proton Pump Inhibitors (PPIs) are incredibly popular. By one estimate, nearly 8% of adults took a prescription drug like esomeprazole (Nexium), lansoprazole (Prevacid) or omeprazole (Prilosec) in the previous month (JAMA, Nov. 3, 2015). That doubtless underestimates the numbers as it did not include over-the-counter use. Despite the popularity of PPIs, there is a growing list of serious side effects linked to such drugs. Kidney damage is just the latest worrisome adverse reaction. A reader expresses her concerns:

Rising Creatinine and Kidney Damage?

Q. I have been taking various PPIs for a decade. I am 76 and my creatinine is creeping up in the blood tests at my regular checkups. This could be my age, but I worry that the PPI I take for heartburn might be making it worse.

My doctor says not to worry; he is also taking one. But as I age, I am concerned about drug side effects. I decided to go off these pills.

I started by cutting them in half, then taking half every other day. I was able to take that half dose just a couple of times a week and now I’m off altogether.

I am careful about what I eat. I drink cold water if I get a little heartburn. Sucking on a hard candy increases saliva and that also helps with reflux.

A. A creatinine blood test helps doctors assess kidney function. Rising levels could be an early indication of kidney damage.

There is evidence that long-term use of proton pump inhibitors (PPIs) may be harmful to the kidneys (Kidney International, Feb. 22, 2017).  Other side effects associated with PPI use include pneumonia, intestinal infections, hip fractures, nutritional deficits and dementia.

Allison in Boston shared her story about long-term complications of PPIs:

“I believe that PPIs (proton pump inhibitors) create more problems than they solve. It took me three tries, over several years, to extricate myself from these drugs, after their being prescribed to me for GERD for 15 to 20 years.

“During that period, I developed Vitamin B12 deficiency and osteoporosis as well as sporadic, diarrhea-predominant IBS. I also had a bout of C. difficile colitis. I suspect that PPIs either caused or contributed to all of these conditions and events.”

Do NOT Stop PPIs Abruptly!

Some people have to take proton pump inhibitors for a long time because of a serious medical condition. No one should ever stop any medication without first checking with the prescriber. People who must take PPIs for long periods of time should ask their physicians to order kidney function tests periodically to make sure kidney damage is not occurring.

Suddenly stopping a PPI such as omeprazole can cause rebound hyperacidity. Here are some stories from readers who tried to discontinue their proton pump inhibitor:

S.K. in Texas has had terrible trouble:

“I have been on Nexium for 7 years now because of heartburn. It’s what my doctor put me on. He told me that after 2 months if my symptoms are still there then I should see a gastroenterologist. Seven years later, I am still taking Nexium because I am scared to go to the doctor and find out what is wrong with me.

“I have tried coming off of this medication with no luck at all. I was taking a pill every other day and still had some symptoms, but I was chewing tums.

“It’s been 5 days since I’ve taken a Nexium and today has been horrible. I have vomited twice because of the heartburn. I never knew it would be so hard to come off of this medication.”

We encourage S.K. to see a gastroenterologist to find out what IS going on.

Vincent in Andover, NJ shared this:

“I have been on Nexium for 20 years and could never get off the medication because of severe stomach pain from GERD. I have tried many times to get off Nexium. My kidney function is low and I broke my ankle not too long ago. I am not feeling myself. I am tired most of the time.”

Lynn wants to know what to do for rebound hyperacidity:

“I have been taking Prilosec 20mg for a very long time. At first, twice a day. The past year, once a day.

“I tried to get off once. After a few days I thought I was dying. The acid reflux was so bad. I went back on. I didn’t know about the side effects then. Now I want to try again because I had bad memory problems, severe leg cramps and headaches.

“I will try the “DGL” licorice tablets and probiotics and maybe the persimmon tea. But what do you do when the persimmons are not in season. Is there a pre-made tea you can buy in the store? I have access to persimmons when they are in season but the season is gone. I also have IBS and I wonder if this is also a result of taking Prilosec. I would like to hear from more people about what works for them.”

Learn more about other strategies for dealing with heartburn at this link:

No Vacancy at the Heartburn Hotel

No Vacancy at the Heartburn Hotel

Our Guide to Digestive Disorders offers other ways of dealing with heartburn and easing off PPIs. Anyone who would like a copy, please send $3 in check or money order with a long (no. 10) stamped (70 cents), self-addressed envelope:

  • Graedons’ People’s Pharmacy, No. G-3
  • P. O. Box 52027
  • Durham, NC 27717-2027.

It can also be downloaded for $2 from the website: www.peoplespharmacy.com.

 

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  1. Lynn
    Campbell, CA
    Reply

    I have been taking Prilosec for many, many years going from 2 20mg. Down to 1 and started recently going to one every other day. I noticed an increase in the burning but continued to drop all pills on a recent Friday. The whole weekend was so unbearable I was sobbing with pain and praying a lot. Tums did not help. Even water was making me burp and still had the fire in my stomach.

    I did get a liquid Antacid 4-5 times a day and went on chicken broth, Jello, water and finally after 3 days I added a scrambled egg, after 2 more days I added Mac & cheese. As of now, I can have regular soup. All soft foods and water.

    I have minimal pain and can feel like I can live again. This is a slow painful process but as of now(6 days later) I feel so much better. I will now try the tea and other things recommended. I think I will always have to watch my acidic foods and stay with non-spicy foods.

  2. Jay
    N C
    Reply

    I was on Prilosec for 3 yrs. Big gut ache but no reflux. Could not stop talking Prilosec. Finally got my doctor to get some tests. An endoscopy showed that I had a valve in my stomach blocked. Removed the blockage and never had another pain again. I am 80+ and can eat anything and no gut meds.
    I never needed reflux meds in the first place.
    Hope this helps.

  3. Dave
    New Hampshire
    Reply

    I took PPIs for 6 years and they barely did the job to relieve heartburn. After endoscopy my doctor urged me to keep taking them. Then I read that as we get older the tendency is for the stomach to produce less acid, not more, and that sometimes adding acid with a supplement during meals can take care of it, with DGL as an assist. It worked, to my amazement! During the tapering period I also had sugar free gum at the ready, and it did take a few months to get off the PPI, but now I am glad I did!

  4. Joanne
    WI
    Reply

    I have been on PPI’s for re-flux larynx 16 yrs. I noticed that my voice had changed in addition “carrying a tune” is next to impossible. For yrs it was 1 pill daily, vs presently 2 pills wkly. I feel better and my voice seems to have stabilized, still can’t sing worth two cents. Fortunately cutting down my meds was not difficult, no side affects/problems.

  5. Betty
    Reply

    My husband suffered from GERD for a number of years and when an endoscope showed signs of Barrett’s Syndrome, he started looking for another way of dealing with his reflux disease. We read about a surgical procedure call Fundoplication and this literally changed his life. When his gall bladder needed to be removed, the same doctor did both surgeries at the same time. I encourage anyone who has been on GERD medications for years like my husband to look into this procedure. He had his Fundoplication in 2010 and rarely if ever gets any heartburn.

  6. Rihard
    Reply

    I switched to Zantac. The original heart burn medication. Little to no problem Once in a while I need to chew a tums at night.

  7. Steve
    IN
    Reply

    I was taking omeprazole every day and sometimes it made me hurt more than the reflux. I did some research and went to a low acid diet. I gradually weened myself off the drug. One every other day, then half a day, every other day and every third day and was finally able to stop taking the pill. Low acid means no citrus, tomatoes, spicy food, chocolate, etc. (a lot of the foods we all like to eat). When I cheat and get reflux, baking soda and water or a couple Tums takes care of it. I have many friends who take a pill every day. Even though it is an over the counter medication, your body still gets hooked on it.

  8. jerry
    Reply

    Taking 2 gel caps of simethicone (GasX or equivalent) each day works for me. I know of no side effects of this OTC medication.

  9. RP
    Reply

    (TL;DR – giving up alcohol, caffeine and wheat appears to have cured my heartburn).

    I suffered from frequent heartburn for over a decade. It was accompanied by a constant feeling of being tired/not having slept well and a cough, in particular in the morning. The tiredness and heartburn kept getting worse as time went by.

    I took PPIs for a year or two, on the recommendation of my doctor, but stopped taking them when I noticed that they seemed to be giving me tinnitus. (If I had known then what I do now about PPIs, I would never have gone anywhere near them). For a long time I just put up with the heartburn and ate antacids like candy. Occasionally I would try to give up certain foods, alcohol and caffeine, but it didn’t seem to make much difference (alcohol and caffine would trigger acute heartburn but if I gave them up, I still had frequent heartburn after meals etc); nor did tilting my bed slightly and various other things I tried.

    Last year, having read online that cutting out carbs could help, I tried an Atkins-style low carb diet, combined with once again giving up all caffeine, alcohol and hot drinks. I found that the heartburn went away almost entirely, as did the tired feeling. The diet was however somewhat difficult to maintain (it made it difficult to eat with my family), and I stopped it after a month, which brought the heartburn and fatigue back. I went back to avoiding alcohol and caffeine (and hot drinks generally), and noticed one day that eating bread seemed to bring the heartburn on. So without going full-on low carb again, I stopped eating wheat (while also continuing to avoid caffeine and alcohol). It’s only been a few months, but this seems once again to have eliminated the heartburn and the tiredness almost completely. I had some other on-going stomach issues after the heartburn went away but these seem to have cleared up since I cut out cashews and dark chocolate, both of which I’d been eating in quite large quantities (though it’s only been a few weeks).

    A beneficial side effect of the wheat free/low-ish carb diet, combined with a time-restricted eating regime (making sure to consume nothing other than water for at least twelve hours every night) is that I’ve lost more than 20 lbs of weight, mostly from my previously biggish gut. (I don’t think the time-restricted eating is the main factor behind the improvement in my heartburn, as my heartburn also went away when I went on the Atkins diet and wasn’t doing time restricted eating – though I imagine it also helps).

    It seems to me that it’s a good idea to explore changes in diet to address heartburn/reflux rather than take some sort of treatment, whether it’s PPIs, antacids or even the likes of licorice, apples or apple cider vinegar. Heartburn is presumably a sign that something is going wrong in your body. Even if medication doesn’t have side effects (which PPIs for example clearly can do), solving it by taking medication, a herbal remedy or what have seems at least as likely to me to be treating the symptoms rather than whatever the underlying cause is. As I understand it, doctors often say that there’s little evidence for pursuing changes in diet to treat heartburn, but this is mainly down to the fact that no-one’s really bothered to look for such evidence, rather than research having been done and coming up short-handed.

  10. Ed
    Florida
    Reply

    After being on it for 9 months read many articles about Nexium. Could not believe my doctor actually prescribed this for my acid re flux. Admittedly, it cured my heartburn. But at what cost. I weaned my self off by pouring out 50% of the capsule for a month then 75% for another month. Supplemented it with Pepcid Complete and Tums. I try to stay off tums because I am prone to kidney stones. Have now been completely off the Nexium for over a year. I take the Pepcid when I feel heartburn coming on (probably every other day), take a swig of liquid antiacid at bedtime and sleep on two pillows. Re flux handled.

  11. joan Koenecke
    Reply

    I had been taking prilosec for several years. At first it was a godsend. My Gerd and heartburn were gone. But when I decided I had better stop taking it. I got a 15 mg generic from a big on line store. I took them for 2 weeks. Then took one every other day, then cut them in half. My heartburn at this point was just about gone along with the gerd.I got a bottle of Pepsi complete. The one with the big red lid. The Dr had told my husband to take it because he would not take the ppi. That got me over the hump. But. I think what really solved the problem was weight loss. After my husband passed away, after 55 years of marriage I was understandably upset, not eating and so forth. I lost nearly 50 lbs. But by then I also noticed that I was feeling better. The heartburn was gone. Now every now and then I need a pepsid. Those things get rid of the heartburn in less than 5 min. I don’t need them much now. Every two or three weeks I may have eaten something that caused a problem but the pepsid takes it away. Watching your diet and losing belly fat plays a big part in heartburn. Tomatoes ace and milk seem to trigger it for me.

  12. Beverly Oktavec
    Portland,CT
    Reply

    I have been taking Omeprazole prescribed by my doctor for colitis, heartburn and reflux but I lost a kidney. So I stopped taking the medicine-I don’t want to lose another

  13. Chez
    Australia
    Reply

    Just try taking some Aloe Vera Juice , about 1 tablespoon diluted in half a glass of water and/or a teaspoon of Carnation milk when you feel the heartburn coming on. This works for me.

  14. Joann
    Texas
    Reply

    I was only on Prilosec for a couple of years when I decided to stop taking it after reading about the complications from this drug. I am trying other things like adding fermented veggies to my diet. This seems to help. I am also drinking kefir. My daughter is pregnant and getting heartburn and told me she gets great results by drinking coconut water. She said the brand she was told to use because of it’s quality was Nirvana.

  15. Sally
    USA
    Reply

    I took Prilosec for 6 years after my doctor prescribed it. Then I started having severe pain from gallbladder attacks in the middle of the night. My gastroenterologist tested me and found my gallbladder was all but destroyed, and had to be removed. He believes Prilosec was the culprit. I haven’t seen any reference to this side effect on the gallbladder.

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