Proton pump inhibitors such as esomeprazole (Nexium), lansoprazole (Prevacid), omeprazole (Prilosec) or pantoprazole (Protonix) have become such staples of treating heartburn and digestive distress that doctors may not think beyond this toolbox. But they are not appropriate for everyone.
This reader found a physician willing to consider a different approach to her acid reflux. We don’t know if it would work well for other readers, but it might be worth consideration.
Prilosec Did Not Ease Symptoms of Reflux:
Q. I am a 72-year-old woman. About nine months ago, I suddenly came down with a bad case of acid reflux. My doctor prescribed Prilosec, which had awful side effects and did not help much.
With the help of your booklet on digestive disorders, I tapered off the medicine, modified my diet drastically and drank a lot of ginger tea. I finally consulted a gastroenterologist who prescribed Cytotec.
I took this drug for four weeks. It worked without too many side effects and I am keeping my fingers crossed. Apparently, it can cause miscarriage, but that is not a problem for me.
How does Cytotec ease acid reflux? What can you tell me about it?
Controlling NSAID-Related Damage:
A. Misoprostol (Cytotec) protects the stomach from damage caused by aspirin and other pain meds like diclofenac, ibuprofen and naproxen.These NSAIDs (nonsteroidal anti-inflammatory drugs) block a natural compound called prostaglandin E1 (PGE1), which protects the stomach lining.
Misoprostol supplies synthetic PGE1 to the digestive tract and helps ulcers heal.Back when it was first introduced in the mid to late 1980s, doctors were excited about its protective potential (Postgraduate Medicine Journal, 1988: Suppl. 1). By the late 1990s, research was showing that omeprazole worked just as well for healing ulcers and many people seemed to like omeprazole better (New England Journal of Medicine, Mar. 12, 1998).
PPI Side Effects:
That was, however, before the many side effects of the PPIs had surfaced. We now know that they can deplete the body of vitamin B12 or magnesium (PLoS One, Nov. 13, 2014), increase the risk of bone fractures (Bone, Aug. 28, 2015), boost the chance of developing diarrhea from a C diff infection or pneumonia (Expert Review of Clinical Pharmacology, July, 2013) and raise the possibility of a heart attack (Circulation, online July 3, 2013).
Even more alarming, the use of proton pump inhibitors together with NSAID pain relievers can intensify the damage caused to the small intestines (Clinical Gastroenterology and Hepatology, Oct. 29, 2015). Misoprostol, on the other hand, protects against such damage, at least in rats (Journal of Pharmacology and Experimental Therapeutics, Feb., 2014).
Misoprostol Side Effects:
In addition to the miscarriage that you mentioned, misoprostol can cause severe changes in blood pressure and heart rhythm, blood clots (thromboembolism) and even heart attacks. So it is not a purely benign drug.
Common side effects include diarrhea, stomachache, nausea, gas and headache.
We don’t know if your doctor selected Cytotec for you because you take aspirin or ibuprofen for joint pain, as you didn’t mention that. It certainly has its own side effects, some of them serious, but as a way of protecting your gut from NSAID damage, it has advantages.