Discontinuing Proton Pump Inhibitors: How do I Get Off My Stomach Medications?

Dr. Sharon Orrange
Dr. Orrange is an Associate Professor of Clinical Medicine in the Division of Geriatric, Hospitalist and General Internal Medicine at the Keck School of Medicine of USC.
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Since proton pump inhibitors (PPIs) are now one of the top ten medications prescribed, and are readily available over the counter, there has been growing concern about the long term use of PPIs like omeprazole, pantoprazole, and esoeprazole. Many folks stay on these medications for years to treat gastroesophageal reflux disease (GERD), so as with many long term medications drug safety becomes an important issue.

There are four main concerns about long term use of PPIs:

  1. Pneumonia.  Gastric acid inhibition (which is what PPIs do) places you at risk for more infections because bacteria and other pathogens live more easily in the upper gastrointestinal tract without the acidic environment. This may be why proton pump inhibitory therapy is associated with an approximately 2-fold increased risk of developing community-acquired pneumonia.
  2. Clostridium difficile (C diff) infections. Long term PPI users are at increased risk for contracting c diff, which causes severe diarrhea and abdominal pain.
  3. Dementia. Emerging evidence suggests that men and women with dementia were 1.5 and 1.4 times, respectively, more likely to be taking proton pump inhibitors. PPIS may cause the accumulation of plaques that have been found to increase dementia risk.
  4. Bones. Absorption of calcium and magnesium is affected by long term PPI use, which may lead to bone disease and increased fracture risk. Long term PPI use has been associated with high risk of hip fractures in the elderly.

Tips for getting off your proton pump inhibitor

I tried to go off my PPI and my symptoms came back. Now what?

Bottom line about proton pump inhibitors: lowest dose, shortest duration.

Dr. O

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