Proton Pump Inhibitors

What are proton pump inhibitors?

Proton pump inhibitors (PPIs) are a group (class) of medicines that work on the cells that line the stomach, reducing the production of acid. They include esomeprazole, lansoprazole, omeprazole, pantoprazole and rabeprazole, and have various different brand names.

What conditions are proton pump inhibitors used to treat?

PPIs are commonly used:

• To treat ulcers in the stomach and the part of the gut called the duodenum.
• To reduce acid reflux which may cause heartburn or inflammation of the gullet (oesophagitis). These conditions are sometimes called gastro-oesophageal reflux disease (GORD).
• As one part of treatment to get rid of Helicobacter pylori - a germ (bacterium) found in the stomach, which can cause ulcers.
• To help prevent and treat ulcers associated with anti-inflammatory medicines called non-steroidal anti-inflammatory drugs (NSAIDs).
• In a rare condition called Zollinger-Ellison syndrome.
• In other conditions where it is helpful to reduce acid in the stomach.

PPIs usually work very well to reduce stomach acid and to treat the above conditions. They have made a big impact on the quality of life of many people with these conditions since they first became available in the 1980s. They are commonly prescribed.

How do proton pump inhibitors work?

Upper gastrointestinal tract and acid

Your stomach normally produces acid to help with the digestion of food and to kill germs (bacteria). This acid is corrosive so your body produces a natural mucous barrier which protects the lining of the stomach from being worn away (eroded).

In some people this barrier may have broken down allowing the acid to damage the stomach, causing an ulcer. In others there may be a problem with the muscular band at the top of the stomach (the sphincter) that keeps the stomach tightly closed. This may allow the acid to escape and irritate the gullet (oesophagus). This is called 'acid reflux' which can cause heartburn and/or inflammation of the gullet (oesophagitis).

PPIs stop cells in the lining of the stomach producing too much acid. This can help to prevent ulcers from forming or assist the healing process. By decreasing the amount of acid, they can also help to reduce acid reflux-related symptoms such as heartburn.

They are called 'proton pump inhibitors' because they work by blocking (inhibiting) a chemical system called the hydrogen-potassium adenosine triphosphatase enzyme system (otherwise known as the 'proton pump'). This chemical system is found in the cells in the stomach lining that make stomach acid.

Can I buy proton pump inhibitors?

You can buy omeprazole, lansoprazole and pantoprazole over the counter at pharmacies. Rabeprazole still requires a prescription. However, if you need to use a PPI for more than four weeks you should consult your doctor.

How do I take proton pump inhibitors?

Your doctor will advise you of the dose needed and how often you should take it. Some of these medicines need to be taken in a certain way, such as on an empty stomach. Therefore, read the leaflet that comes with your particular brand for further information.

How quickly do proton pump inhibitors work?

Generally, PPIs are well absorbed by the body and may provide quick relief for some problems. For example, heartburn caused by acid reflux. However, if you are taking them for other reasons, such as to heal an ulcer, it may take longer for the medicines to have an underlying effect.

How long is treatment needed?

This can vary depending on the reason you are taking a PPI. So, speak with your doctor for advice. For example, in some cases your doctor may prescribe a PPI that you only take 'as required' to relieve your symptoms, rather than every day. In some cases a regular dose taken each day is advised.

Will my symptoms return after treatment with a proton pump inhibitor?

It is possible that your symptoms might come back if you stop your medication. If this happens, see your doctor again.

Who should not take proton pump inhibitors?

PPIs may not be suitable for some people - for example, people with certain liver problems. Breastfeeding or pregnant mums should avoid them apart from omeprazole which is deemed to be safe. A full list of individuals who should not take a PPI is included with the information leaflet that comes in the medicine packet. If you are prescribed or buy a PPI, read this to be sure you are safe to take it.

Proton pump inhibitors side effects

Most people who take a PPI do not have any side-effects. However, side-effects occur in a small number of users. The most common side-effects are:

• Constipation
• Diarrhoea
• Wind (flatulence)
• Headaches
• Feeling sick (nausea)
• Tummy (abdominal) pain
• Being sick (vomiting)

Recent research has found a link between long-term treatment with PPIs and gastric cancer, although further studies are needed. A group of medicines known as H2 blockers are therefore preferred for long-term use. Some people find that only PPIs control their symptoms. Each individual needs to take advice from their doctor, and weigh up the risks and benefits.

For a full list of possible side-effects and cautions, see the leaflet that comes in the packet with your particular brand.

In particular: tell your doctor if you are taking the blood-thinning medicine warfarin, or a medicine for epilepsy, called phenytoin (Epanutin®), or medicines called digoxin, methotrexate or cilostazol. Taking a PPI can affect how well these medicines work, or can even cause serious 'drug reactions'. Also, lansoprazole possibly affects how well oral contraceptives might work. Discuss this with your doctor if it is relevant to you.

If you are taking antacids you should try to avoid taking them at the same time as you take your other medication, including PPIs. This is because antacids can affect how well your medication is absorbed.

Other considerations when taking a proton pump inhibitor

You should consult your doctor if your symptoms worsen, or if you experience any of the following problems which can indicate a serious gut disorder:

• Bringing up (vomiting) blood. This may be obviously fresh blood, but altered blood in vomit can look like ground coffee. Doctors call this 'coffee-ground vomit'.
• Blood in your stools (faeces). This may be obvious blood, or it may just make your stools black.
• Unintentional weight loss.
• Difficulty swallowing, including food getting stuck in the gullet (oesophagus).
• Persistent tummy (abdominal) pain or persistent vomiting.