Proton pump inhibitors (PPIs) reduce the amount of acid made by your stomach. They are commonly used to treat acid reflux and ulcers of the stomach and part of the gut called the duodenum. Most people who take a PPI do not develop any side-effects.
What are proton pump inhibitors (PPIs)?
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 (PPIs) 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 (PPIs) work?
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 (PPIs)?
Most of these medicines are prescription only. You can buy omeprazole and pantoprazole over-the-counter at pharmacies. However, if you need to use this medicine for more than four weeks you should consult your doctor.
How do I take proton pump inhibitors (PPIs)?
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 (PPIs) 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 to 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 (PPI)?
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)?
PPIs may not be suitable for some people - for example, people with certain liver problems. Breast-feeding 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.
What about 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:
- Wind (flatulence)
- Feeling sick (nausea)
- Tummy (abdominal) pain
- Being sick (vomiting)
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.
Clinical Editor's note
November 2017 - Dr Hayley Willacy has been reading recent reports concerning long-term use of PPI medicines and an increased risk of gastric (stomach) cancer - see Further reading below. Researchers from Hong Kong studied 63,397 people who'd been treated for stomach infection with H. pylori bacteria. Even after the bacteria had been killed, those who took PPIs on a long-term basis were more likely to be diagnosed with stomach cancer in the following 7 to 8 years of follow-up. Because of the study design, we can't tell if PPIs were the cause of the increased stomach cancer risk. It could also have been down to other factors. For instance, the people studied were Chinese and we now that Asian people already have a higher risk of stomach cancer than the general European or US population. The amount of alcohol or how much these people smoked are also key factors and unfortunately, this was not looked at in the study. It is also important to keep the results in proportion. Long-term use of PPIs was linked to around 4 additional stomach cancers cases per 10,000 people per year. The overall risk is still very low.
How to use the Yellow Card Scheme
If you think you have had a side-effect to one of your medicines you can report this on the Yellow Card Scheme. You can do this online at the following web address: www.mhra.gov.uk/yellowcard.
The Yellow Card Scheme is used to make pharmacists, doctors and nurses aware of any new side-effects that medicines or any other healthcare products may have caused. If you wish to report a side-effect, you will need to provide basic information about:
- The side-effect.
- The name of the medicine which you think caused it.
- The person who had the side-effect.
- Your contact details as the reporter of the side-effect.
It is helpful if you have your medication - and/or the leaflet that came with it - with you while you fill out the report.
Other considerations when taking a proton pump inhibitor (PPI)
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:
- Bring 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.
- Persistent tummy (abdominal) pain or persistent vomiting.
Further reading and references
Cheung KS, Chan EW, Wong AYS, et al; Long-term proton pump inhibitors and risk of gastric cancer development after treatment for Helicobacter pylori: a population-based study. Gut. 2017 Oct 31. pii: gutjnl-2017-314605. doi: 10.1136/gutjnl-2017-314605.
The management of dyspepsia in primary care; MeReC Briefing, No 32, 2006
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