Heartburn: Proton Pump Inhibitors

Proton Pump Inhibitors

What are Proton Pump Inhibitors?

Proton Pump Inhibitors or PPIs are a group of drugs that help reduce the production of stomach acid. They are available without a prescription (Prilosec®, Prevacid®, and Zegerid®) for the treatment of heartburn; or with a prescription (Nexium®, Protonix®, and Aciphex®) for the treatment of heartburn, GERD, ulcers, esophagitis and other stomach acid related conditions.

When it comes to managing your heartburn symptoms over a 24-hour period, PPIs are very effective medications. In fact, PPIs are frequently the first medication doctors look to when treating people with frequent heartburn (heartburn that occurs two or more times a week) or GERD.

How do PPIs work?

Inside your stomach lining are special cells called parietal cells. Your parietal cells contain enzymes that make hydrogen ions. These hydrogen ions are pumped into your stomach where they create stomach acid.

So how do PPIs work? PPIs neutralize the active enzymes in some parietal cells. When the enzymes are neutralized, fewer ions are pumped out. This means the acid in your stomach becomes weaker. It can take the parietal cells 24 hours or longer to make more enzymes. That's why PPIs are effective at keeping heartburn symptoms away all day.

However, for a PPI to work properly, it has to be taken on an empty stomach. That's because PPIs only neutralize the enzymes in active parietal cells. These don't become active until you start to eat. Since it takes a while for PPI to circulate in your blood stream, it's important to take at least 60 minutes before eating. That way, once the cells become active, the PPIs are ready to neutralize their enzymes.

Can I still get heartburn when taking a PPI?

Relief is much slower with PPIs than with other heartburn medications. And, they must be taken daily and at the correct time so they can continue to work. Sometimes complete symptom relief can take up to 4 days. In one study, only about 30% of people had their symptoms go away on the first day.

Even though PPIs are extremely effective, more than 46% of people taking them can still experience heartburn "breaking through" their PPI's control. Because taking another PPI dose is unlikely to help in these situations, many turn to strong antacid like TUMS Ultra® to relieve their breakthrough heartburn symptoms.

Are PPIs right for me?

If you experience heartburn symptoms twice a week or more, PPIs may be the right treatment for you.

Only take a PPI for heartburn if you experience symptoms two or more times a week. The FDA has approved non-prescription PPIs for once-a-day use up to 14 days. And unless your doctor tells you otherwise, these non-prescription products shouldn't be taken again for at least four months.

If you have liver problems, are under the age of 18, pregnant, planning to become pregnant or breastfeeding, PPIs are not for you. When in doubt, read the packaging and always talk with your healthcare professional to make sure PPIs are the right treatment for your heartburn symptoms.

Are PPIs safe?

PPIs are taken by millions of Americans every day without any problems. However side effects like headaches, abdominal pain, nausea, diarrhea, vomiting and flatulence can occur.

When taken for many years, PPIs have been associated with an increase in bone fractures. A study with people over the age of 50 showed a connection between dosing and hip fractures. This risk was seen in people taking a PPI for a year or more, or who were taking high PPI doses (e.g. twice a day). PPIs have also been associated with certain types of infections.

As with any medication, if you are concerned about safety talk to your healthcare professional.

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