Man with Heartburn, risks of Pepcid Complete, wreck your digestion

According to our calculation (based on the most recent data available), more than 110 million prescriptions for proton pump inhibitors (PPIs) are filled each year. That does not count the tens of millions of pills purchased over the counter. Most folks assume that these heartburn drugs (PPIs) are extremely safe for easing symptoms of indigestion. But questions have been raised about a connection to stomach cancer after long-term use.

A Reader Worries about Heartburn Drugs (PPIs) and Stomach Cancer:

Q. I have taken PPIs for reflux over several years. I asked the gastroenterologist if there would be any danger in taking them long term, and he said no.

I’ve had a scope of my stomach and esophagus that showed no problems. That was a few years ago. I’ve read that acid-suppressing drugs can lead to cancer. Do I need to have any tests to see if I have undetected stomach cancer or other problems?

A. Proton pump inhibitors (PPIs) are powerful acid-suppressing drugs. They include esomeprazole, lansoprazole, omeprazole and pantoprazole. Most of these drugs are now available over the counter for heartburn.

When the FDA approved PPIs, they were thought to be among the safest drugs in the pharmacy. Over the last decade or so we have learned about some unexpected adverse reactions associated with long-term use.

They include magnesium and vitamin B12 deficiency along with bacterial overgrowth in the small intestine. Other possible complications include weakened bones, fractures, chronic kidney disease and heart attacks (Heart, Lung, & Circulation, online Nov. 20, 2017).

Heartburn Drugs (PPIs) and Cancer?

The potential link between PPI use and stomach cancer is much more controversial. A meta-analysis suggests there is an association (Clinical Gastroenterology and Hepatology, Dec. 2016).  A recent study has confirmed this connection (Gut, Jan. 2018).

Most of the gastroenterologists we know love PPIs. That is because they help heal stomach ulcers quickly and more effectively than prior medications. They also control heartburn symptoms. And many gastroenterologists are firmly convinced that PPIs will protect the esophagus from cancer. When cells at the bottom of the esophagus turn wonky, doctors worry about Barrett’s Esophagus. This can turn into very hard-to-treat esophageal cancer.

Our Questioner Requires Repeat Endoscopies!

Ask your doctor how frequently you should schedule endoscopies to check for suspicious growths or stomach cancer. You may find our Guide to Digestive Disorders helpful. It offers other options for managing heartburn. Anyone who would like a copy, please send $3 in check or money order with a long (no. 10) stamped (71 cents), self-addressed envelope:

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

It can also be downloaded from the website:

Will PPIs Protect You from Esophageal Cancer?

There is a video in this article that discusses other options for controlling heartburn.

Will PPIs Protect You from Esophageal Cancer?

People’s Pharmacy Perspective:

Some people absolutely must take a PPI. For example, a condition called Zollinger-Ellison syndrome is rare but challenging. It is caused by tumors in the small intestines or in the pancreas. The tumors (gastrinomas) make way too much gastrin. This compound causes the stomach to churn out huge amounts of acid.

The result is really bad heartburn, abdominal pain, reflux, and generalized digestive distress. It will likely be necessary to have surgery to remove the gastrinomas. In addition, most gastroenterologists will prescribe PPIs to control the excess acidity.

Never Stop Heartburn Drugs (PPIs) Suddenly!

No one should ever stop a PPI suddenly on their own. It is essential to discuss this with the prescribing physician and see if you can come up with a sensible path forward. You may find the following article of help, if the prescriber agrees.

Getting Off Omeprazole

Getting Off Omeprazole

Share your own PPI story below in the comment section.

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    I suffer from indigestion but if I eat an apple when the symptoms appear, the problem is solved.

  2. Carole
    Sydney, Australia

    I worked out that PPIs were causing fungal growth in the bowel. It is causing low stomach acidity which fails to kill pathogens, allowing them to grow in the gut.
    Isn’t this prescribing of PPIs rather wrong thinking? Surely a better closure at the top of the stomach, and losing visceral fat which pushes up the stomach would be better to stop reflux.

  3. Karen
    North Carolina

    I was on PPIs for years and years. During my second pregnancy my son’s head was jammed into my stomach for weeks causing my first reflux experience. After delivery I was put on Mylanta, but that didn’t help much. I tried to never eat if I was going to be laying down soon after. After years of distress I was given a PPI and had such relief.

    Then, years later I found out how horrible PPIs are. I didn’t know not to just quit cold turkey, but I did. I had horrible reflux for a couple days relieved somewhat by drinking ACV. Then, I started eating my evening meal at 4pm. That worked well and I could lay down at night and sleep peacefully.

    I slowly worked my evening meal up so that now I eat at 6pm and do fine. I found, on People’s Pharmacy, to eat a small handful of almonds for reflux. Now and then I will have some reflux and the almonds take care if it right away. Now, I am so pleased and happy to announce People’s Pharmacy is my life saver. If I hadn’t read about PPIs on your site I would still be taking them. Also, delighted about the almond reflux treatment!

  4. Rosemarie
    Lawton ,Ok

    Can you tell me anything About HEM OIL Thank you

  5. Joyce

    My husband has Barretts and has been on PPI’s for several years and has no motility in his esophagus. We were concerned about them. He did take sublingual B12 because of them. Doc recommended botox in the esophagus and it’s been about a year and a half now and no problems and no meds. Worked great. The doc said it could last a month to years. Great.

  6. Faye R.

    I was wondering about prolong use of Tums, Rolaids, Pepto B, etc. Do or can these have the same side effects? Surprised there was no mention of raw apple cider vinegar, which is a big help with replenising digestive acids and calming heartburn. Can be hard to take though, I mix mine with a little juice or honey.

  7. Dolores
    Seminole, FL

    I had GERD w/o symptoms. I always felt like I had mucus in my throat and “cleared my throat” constantly. My Pulmonary doctor placed a probe going through my nose and ending up in the back of my throat. It recorded how many times I experienced Gastro Reflux and it was off the charts! I went to a Gastro doctor and had an endoscopy with biopsy to rule out Barrett’s Syndrome. I was prescribed omeprezole which I took for a few months until I “Googled” it and found one of the side effects was it osteoporosis. I had osteopenia and was borderline for osteoporosis. I stopped taking omeprezole and that’s when I experienced heartburn. I’m 87 yrs old and now I am controlling my GERD by diet. I printed 2 lists of foods, Acidic & Alkaline. I also bought litmus strips to test my saliva and it’s 7 right in the center, leaning towards Alkaline! Diet is the answer and when I eat more acidic than alkaline, I experience Gastro Reflux. Rather than take PPIs, etc. I make an old recipe: 1/2 tsp. baking soda, 1/2 tsp. sugar in a juice glass. I fill it with 3 oz with water, stir, and then pour 1 oz of Apple Cider Vinegar. As soon as it fizzes, drink it immediately. It really does the trick. Whereas Gaviscon, Tums, etc. all contain Aluminum!

  8. Golden Girl

    Finally, I got off omeprazole after a failed attempt three years ago when I first read about its dangerous side effects in the People’s Pharmacy column. I had no idea how to do it, except to taper off gradually. My primary care doc didn’t have a clue. Last fall, I went to a ENT doc who diagnosed me with LPR, also known as silent reflux. I had been taking omeprazole for at least 10 years, and it wasn’t helping my acid problem any more. He told me how to stop PPI’s with ranitidine, which is generic Zantac., an H2blocker. I also took Gaviscon Advance from the UK.

    I had bad acid rebound for a couple of weeks and then not as bad for another week or two. But it was manageable knowing it wouldn’t last forever. Also, I was in a couple of really good support groups on Facebook for GERD/LPR sufferers. I am continuing to eat a low acid diet and follow the lifestyle recommendations for GERD/LPR patients. Have lost a significant amount of weight over the last year, too, from the low acid diet. Feel much better now and don’t have the worry of what omeprazole is doing to my health.

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