PPI drugs are not without their side effects

By Dr. Nikolai Bildukewicz

Categories: Featured News, Cancer
For years, anti-heartburn medication was prescribed like candy. Proton-pump inhibitors (PPIs) seemed to cure the symptoms of heartburn, indigestion and acid reflux without any side effects.

Or so we thought more than a decade ago.

Now it seems as though every year researchers discover a new area of the body that has been negatively affected by PPIs. Osteoporosis, pneumonia, infectious diarrhea, and even an increased risk for heart attacks have all been linked to prolonged PPI use. Most recently, a study suggests that PPIs are associated with an increased risk of developing chronic kidney disease.

While the drugs are not proven to cause these conditions, the associations are strong enough that we should stop thinking of PPIs as harmless and start thinking of them as what they are: Temporary relief for symptoms of a chronic and progressive disease.

An estimated 15 million Americans use PPIs, and for good reason. PPIs revolutionized the medical treatment of reflux, and for mild or intermittent symptoms, they're fantastic.

But they have worked so well at masking symptoms that people too often take the drugs longer than they should. Sold by prescription as well as over-the-counter under a variety of brand names, these pills were never intended for prolonged daily use.

Instead of constantly reaching for that little purple pill, it's time to seriously consider the underlying cause of acid reflux and attack the problem, not the symptoms. Gastro-esophageal Reflux Disease (GERD) is caused by a weakened lower esophageal sphincter, a little bundle of muscles between the stomach and the esophagus that allows food in and is supposed to keep stomach acid, digestive enzymes, and food from coming back up.

The gold standard for treating this weakened sphincter is surgery. I'm a surgeon, so perhaps it's not a surprise that I'm extolling the virtues of surgery.

But my convictions are backed up by facts. Historically, surgery has proven over 90% effective in stopping GERD, which is why physicians have been performing surgeries to reinforce the lower esophageal sphincter since the 1950s.

The most common procedure is called a Nissen fundoplication. In this laparoscopic surgery, the surgeon wraps the top of the stomach around the lower esophagus. This reinforces the lower esophageal sphincter, making it less likely that acid will back up into the esophagus. Surgery is not without its side effects. Many people experience bloating, an inability to burp or vomit, as well as other symptoms.

As a solution to those side effects, in 2012 the FDA approved a new device for GERD called the LINX Reflux Management System. It is a small flexible band or bracelet of interlinked titanium beads with magnetic cores that is placed around the lower esophageal sphincter. It augments the natural function of the sphincter, limiting acid, digestive enzymes, and food from refluxing into the esophagus from the stomach.

Along with other surgeons at Hoag, I have been involved in several studies that have confirmed the efficacy and safety of the LINX device. I have seen how the LINX device is dramatically changing the way we surgically treat and manage GERD. Several patients who were part of the initial clinical trial are still doing well, having had the LINX device for over eight years now. Their symptoms of GERD are dramatically improved without the side effects that are commonly found in patients who undergo the traditional Nissen procedure.

Unfortunately, despite the success of surgery, a major barrier remains: Patient education.

Many patients are misinformed and are not aware that their GERD will progress over time. They often look at GERD or reflux as a benign symptom and not a true disease. If not treated appropriately, prolonged GERD can cause severe changes and damage to the esophagus that can eventually lead to esophageal cancer.

I'm hoping that every time a new study comes out linking PPIs to another disease or condition, it will spark a conversation between patients and their primary care providers and/or gastroenterologists about going beyond the symptoms and attacking the problem at its source.

NIKOLAI BILDZUKEWICZ is esophageal and Gastric surgeon at Hoag Hospital and an assistant professor of clinical surgery at USC's Keck School of Medicine.