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What Are Downsides to New Secret Weapon for Heartburn?

We warn a reader to be wary of a secret weapon for heartburn. It turns out to be generic Nexium, and long-term use has potentially serious complications.
What Are Downsides to New Secret Weapon for Heartburn?
Mature 50s Asian man stomachache,  pressing on stomach with painful expression, sitting on sofa at home, medicines on table.

If you frequently suffer from indigestion or “acid stomach,” you might wish for a new secret weapon for heartburn. One reader was excited to discover a “new” drug, not realizing that it is far from new. It was hiding behind an unfamiliar generic name.

Finding a Secret Weapon for Heartburn:

Q. I have discovered a new secret weapon for heartburn. It’s an off-the-shelf drug, esomeprazole magnesium. I have taken Tums for years, with modest results.
My wife bought me this new drug, and I take it once a day. Like magic, I have no more heartburn. I can eat food that has always bothered me, like pizza and spaghetti sauce. I have not taken a Tums in months.

A. We’re not surprised you’ve found this drug helpful. It is the generic form of Nexium 24HR. It works best when taken once a day, as you describe, but you shouldn’t take it for more than two weeks. If you take if for too long, you could experience rebound hyperacidity when you stop. This reaction is so unpleasant that many people decide to keep taking the drug for months or years.

What Are the Downsides of Esomeprazole?

Esomeprazole, like omeprazole (Prilosec), lansoprazole (Prevacid), rabeprazole (AcipHex) and others, is a proton pump inhibitor (PPI). Such medications were initially approved to treat stomach ulcers. They can work well for heartburn, but they may have serious side effects over the long term.


Not all of the downsides are obvious from the function of a PPI as a secret weapon for heartburn. We worry that people who take esomeprazole or another PPI for years might be more likely to develop dementia (Frontiers in Neurology, Jan. 8, 2019). The problem is that these drugs inhibit an enzyme critical for the production of the neurotransmitter acetylcholine (Alzheimer’s & Dementia, May 8, 2020). Without adequate acetylcholine, neurons that should be communicating with each other cannot do so efficiently.


Researchers from the University of Chicago have reported links between PPI use and a condition called microscopic colitis (Annals of Pharmacotherapy, March 2017). People with this problem suffer watery diarrhea and chronic gut inflammation. So PPIs that suppress heartburn may not be uniformly helpful for digestive disorders.

Gut Microbiota Disturbance:

PPIs may disrupt the health balance of microbes in the gastrointestinal tract (Digestion, Jan. 6, 2018). Possibly the most serious consequence of this disturbance is diarrhea due to an overgrowth of Clostridioides difficile (C. diff). However, throwing the microbes off balance can also result in bacterial overgrowth in the small intestine (SIBO), which may contribute to irritable bowel syndrome.


In addition, older people on PPIs run a higher-than-average chance of coming down with pneumonia (Journal of the American Geriatrics Society, July 2018). Microbiota disruption may contribute to this problem. Suppressing bacteria-killing stomach acid might also play a role. 

Heart Attacks:

You might be surprised at the connection, but people who take drugs like your secret weapon for heartburn appear to be more susceptible to heart attacks (PLoS One, June 10, 2015). Other heartburn drugs like cimetidine and ranitidine are not linked to cardiovascular complications.

Bone Fractures:

For years now, doctors have known that long-term PPI users may be more prone to bone fractures, among other adverse effects (Expert Review of Clinical Pharmacology, July 2013). Hip fractures are frequently devastating if not deadly for older individuals. 

What Can You Use as a Secret Weapon for Heartburn?

There are other ways to manage heartburn. Initially, you might need to change your diet and cut back on pizza or spaghetti. Moreover, some home remedies and other medications are less likely to cause similar side effects and might work well enough against your heartburn symptoms. You can learn more from our eGuide to Overcoming Digestive Disorders.

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About the Author
Terry Graedon, PhD, is a medical anthropologist and co-host of The People’s Pharmacy radio show, co-author of The People’s Pharmacy syndicated newspaper columns and numerous books, and co-founder of The People’s Pharmacy website. Terry taught in the Duke University School of Nursing and was an adjunct assistant professor in the Department of Anthropology. She is a Fellow of the Society of Applied Anthropology. Terry is one of the country's leading authorities on the science behind folk remedies. .
  • Novotny M et al, "PPI long term use: Risk of neurological adverse events?" Frontiers in Neurology, Jan. 8, 2019. DOI: 10.3389/fneur.2018.01142
  • Kumar R et al, "Proton pump inhibitors act with unprecedented potencies as inhibitors of the acetylcholine biosynthesizing enzyme—A plausible missing link for their association with incidence of dementia." Alzheimer's & Dementia, May 8, 2020. https://doi.org/10.1002/alz.12113
  • Law EH et al, "Association between proton pump inhibitors and microscopic colitis." Annals of Pharmacotherapy, March 2017. DOI: 10.1177/1060028016673859
  • Naito Y et al, "Intestinal dysbiosis secondary to proton-pump inhibitor use." Digestion, 2018. DOI: 10.1159/000481813
  • Zirk-Sadowski J et al, "Proton-pump inhibitors and long-term risk of community-acquired pneumonia in older adults." Journal of the American Geriatrics Society, July 2018. DOI: 10.1111/jgs.15385
  • Shah NH et al, "Proton pump inhibitor usage and the risk of myocardial infarction in the general population." PLoS One, June 10, 2015. https://doi.org/10.1371/journal.pone.0124653
  • Wilhelm SM et al, "Perils and pitfalls of long-term effects of proton pump inhibitors." Expert Review of Clinical Pharmacology, July 2013. DOI: 10.1586/17512433.2013.811206
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