Medicines for acidity may not be all that safe!

One of the commonest type of drugs in clinical use that bring us relief from “acidity”, by blocking the formation of hydrochloric acid in our stomachs, may not be as innocuous as was earlier. thought Commonly known as proton-pump-inhibitors (PPI), these familiar names such as omeprazole, lansaprazole, pantaprazole or rabeprazole, that we pop so often, are increasingly being shown to have health risks with prolonged use.

A patient of mine, Maya Singh, who was troubled from her young days with severe “heartburn” and acidity, found succor with these medicines. Once troubled by sleepless nights and frequent need to gulp Digene syrup every 2 hours, these new medicines soothed her burning food pipe and provided relief enough to let her sleep peacefully at night.  

Days stretched into weeks into months and into 25 long years. If she missed out a single day’s dose, her “acidity” returned to harass her at night.

Her endoscopic examinations, which had shown redness and mild ulcers due to hyperacidity in 1987, recently showed multiple small “polyps” or tumorous growths in her stomach, a recently recognized consequence of prolonged use of these drugs.

The list of side effects from prolonged use of PPIs is indeed growing. Doctors in ICU have noticed that excess-suppression of gastric acid in critical patients, with the intent of preventing bleeding from the stomach, was associated with higher rates of pneumonia.

Gastroenterologists have now come to recognize that people on PPIs more often have excess germs in their small intestines. This condition called SIBO (small bowel bacterial overgrowth) seems to arise as we subdue the stomach’s capacity to kill wandering germs that try to enter the small bowel with our food.  Recurrent intestinal infections, loose stools and impaired absorption of nutrients are the prices we then land up paying.

Another peculiar problem often seen in such people is the development of “gastrinomas” or tumors that produce a hormone called gastrin that regulate acid secretion. When production of gastric acid is switched off by these powerful drugs, these glands produce gastrin in very high amounts to try and compensate, often ending up as tumors.

Recent studies have also started linking these drugs with osteoporosis, a condition in which our bones become fragile. An even more worrisome is the growing suspicion that gastric cancers may occur more commonly in people who suppress their natural “acid barrier” too much and for too long.

As one section of the medical fraternity is trying to investigate the long term consequences of our interfering with nature by blocking gastric acid, another segment is hard at work trying to develop stronger molecules that would suppress it further and offer better symptom control. 

But nature has her own way of teaching us lessons!

As published in HT City ( Hindustan Times) dated 6th January, 2013.