GERD Medication Safety

Understand the risks and benefits of GERD medications, including proton pump inhibitors.

Contributor

Neil H. Stollman, M.D.

Alta Bates Summit Medical Center

Gastroesophageal reflux disease, also known as GERD, is a serious ongoing condition in which your stomach contents splash back up into your esophagus, causing heartburn and other symptoms, including nausea, vomiting and pain in your chest or abdomen.

Senior woman reading medicine label

You’re more likely to have GERD if you are overweight, a smoker, a pregnant woman or taking certain medications, according to the National Institute of Diabetes and Digestive and Kidney Diseases. About 20 percent of Americans experience chronic GERD.

Many people effectively manage GERD with medications, including proton pump inhibitors. Doctors dispense millions of PPI prescriptions every year; you can also buy some varieties at your local drugstore. These drugs work well against chronic heartburn and acid reflux, but medical concerns about their long-term use recently prompted new Food and Drug Administration warnings.

PPI Concerns

Neil Stollman, M.D., a gastroenterologist with Sutter’s Alta Bates Summit Medical Center, says PPIs reduce the amount of acid your stomach produces; but that effect may prevent your body from absorbing the right amount of calcium, thereby increasing the risk of osteopenia (bone loss) in both men and women.

“If you are taking a PPI, you should consider adding more calcium to your diet or taking a calcium supplement, such as calcium citrate,” Dr. Stollman says.

In addition, long-term PPI use means less stomach acid overall, which makes it easier for “bad” bacteria to grow in your gut, specifically a bug called Clostridium difficile—C-diff for short. C-diff can cause symptoms ranging from diarrhea and abdominal pain to life-threatening inflammation of the colon.

“The world is full of good and bad bacteria, and you are swallowing ‘bugs’ all day long,” Dr. Stollman says. “But we are finding that long-term reduction in stomach acid allows ‘bad’ bacteria to thrive in the body.”

Previously, C-diff primarily occurred in people undergoing long-term antibiotic therapy, but within the last five years doctors started seeing it in patients who were taking PPIs but not antibiotics, suggesting a connection to prolonged PPI use. If you are taking a PPI and experience watery diarrhea, abdominal discomfort and fever, call your doctor right away.

Physicians recommend taking PPIs for the shortest possible time to treat symptoms, and to be cautious of long-term use. If medication of any type is part of your GERD treatment plan, be sure to ask your doctor these questions: