Are PPIs the answer for your acid reflux or GERD?


by Stuart Spechler, MD, AGAF, FACG

Apr 12, 2022

As many as 20% of US adults complain of heartburn and regurgitation—the classic symptoms of gastroesophageal reflux disease or GERD. And proton pump inhibitors, known as PPIs, remain one of the most powerful medicines we have today to provide relief.  

In recent years, it’s become more common for people to ask about the possible side effects of PPIs, especially for long-term use. For people with GERD, however, the benefits of PPIs usually outweigh any potential risks. Here’s what you should know about PPIs and when they may be the right choice for your reflux.

When PPIs are a good option

PPIs target an enzyme in the stomach to reduce how much acid is made, which helps ease reflux symptoms. These drugs take about three to five days to reach maximum effect and work best when taken over time. That means PPIs are for more than just occasional heartburn.

For those who only have heartburn from time to time, faster-acting drugs known as H2 blockers are available over the counter. But if you have ongoing symptoms, PPIs are a better choice in the long term.

The American College of Gastroenterology recommend PPIs for those who have heartburn and regurgitation without other warning signs. If you have additional symptoms, it could signal something more than just GERD.

Warning signs include:

  • Difficulty swallowing
  • Unexplained weight loss
  • Black stool or blood in the stool
  • Vomiting blood
  • Fevers

In that case, you should see a gastroenterologist who specializes in esophageal disease before starting PPIs. Generally, your doctor can use endoscopy to help find the cause of your symptoms.

Long-term safety of PPIs

PPIs are considered a very safe class of drugs. However, over the past 10 years, there have been reports of potentially serious side effects associated with PPI use, from dementia to heart disease to bone fractures.

While this may sound concerning, it’s important to know that these studies were only observational—which means they can never establish a direct cause-effect relationship. The indirect associations reported in the studies do not mean PPIs caused the so-called side effects.

So far, the best studies have found no significant association of PPIs with any of these negative side effects except for a small increase in the risk of enteric infections—or infections in the GI tract.

There is no way any study, no matter how big, can absolutely exclude the possibility of a small risk for a serious side effect of PPIs. But, at the moment, PPIs are the best treatment for GERD, and most people do just fine with them. Talk to your doctor if you have any concerns or fears.

Choosing the right GERD treatment for you

Lifestyle changes

Like any medication, you only want to take PPIs if you truly need them. Some people may try lifestyle changes, such as avoiding foods that trigger reflux, elevating the head of the bed on blocks, quitting smoking or losing weight. While some of these lifestyle modifications may be very good for your overall health (e.g., quitting smoking and losing weight if you’re obese), often, these only go so far in long-term relief of GERD symptoms.

Surgical options

Your gastroenterologist can also talk with you about surgical options to treat GERD. A few different types of surgery exist today. Each has its own benefits and risks, and some may not provide lasting GERD relief for every person. When choosing surgery instead of PPIs, options include:

  • Fundoplication, which wraps part of the top of the stomach around the esophagus to create a valve to prevent reflux.
  • LINX Reflux Management System, which places a bracelet of magnetic beads around the esophagus to keep acid from coming up into it.
  • Transoral incisionless fundoplication (TIF), which uses a device inserted with an endoscope to create a valve at the end of the esophagus without an incision.

Medication and other treatments

Studies continue to find new options for GERD treatment as well. Drugs called potassium-competitive acid blockers (P-CABs), which might provide even better acid control than the PPIs, may come out in the United States in the next couple of years.  

Next steps for treating your GERD

In the end, GERD—and the potential inflammation and damage it could cause—usually won’t just go away on its own. If you have GERD that’s been well-established by a doctor, PPIs are often the best choice for treatment. Surgery also can be a reasonable option for some people. Talk to your doctor and see which treatment is the right answer for you.  

Get care for GERD today.

About the Author

Stuart Spechler, MD, AGAF, FACG, is a gastroenterologist on the medical staff at Baylor Scott & White Center for Esophageal Diseases. Dr. Spechler specializes in diseases of the esophagus, including gastroesophageal reflux disease, Barrett's esophagus, eosinophilic esophagitis and esophageal motility disorders such as achalasia. He attended medical school at Boston University School of Medicine in Massachusetts. His internship, residency and GI fellowship took place at Boston VA Medical Center.

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