PPIs for Chronic Reflux – Understanding the Risks and Considerations

GERD is very common in modern-day American society. Many millions, by some estimations 20-25% of Americans, suffer from chronic reflux. The prevalence and significant increase over the past decade or two are best explained by the explosion in overweight and obesity in the United States during that time. Ultimately, one of the most common reasons for gastric reflux is intra-abdominal pressure caused by excess belly fat pushing on the stomach and forcing caustic gastric juices into the esophagus, essentially burning its sensitive lining.

The Role of PPIs or Proton Pump Inhibitors

The advent and invention of PPIs were a game changer for those with chronic reflux. Before these drugs, patients required antacids, which would work for a while, but ultimately, their mechanism of action was insufficient to help with severe symptoms. On the other hand, PPIs slow the production of acid at its source – in the stomach – so gastric juices are less acidic.

What You Need to Know About PPIs

First, while PPIs can offer significant relief from the acidic burn associated with gastric reflux, they are only indicated for relatively short-term use – six weeks. Even though they are now sold over the counter, this is not a reason to believe they are without risks or side effects. Below are some of the issues associated with long-term PPI use:

• First, the lack of acid in the gastric pouch may allow harmful bacteria like C.dif to proliferate in the colon. This can cause severe gastrointestinal upset and may require antibiotics.
• Long-term and high-dose PPI use has also been associated with an increased risk of bone fracture (especially hip), which can be worse in people with low bone density issues like osteopenia or osteoporosis.
• PPIs only work for as long as they are taken, meaning if patients cannot correct their lifestyle and minimize the symptoms of GERD, or if they are unwilling to have surgery, they will have to take PPIs for the rest of their lives to experience relief.
• Long-term PPI use may also increase the incidence of neuroendocrine tumors in the stomach.
• Lastly, it is not only acid in the stomach that causes damage to the esophagus. Once the stomach juices become more alkaline due to the lack of acid, this, too, can create a caustic situation in the esophagus, leading to slow chemical burns that can eventually cause significant issues.

PPI Alternatives

Understanding these potential risks and considerations, the prospect of surgical repair of the lower esophageal sphincter, or LES, seems far less extreme. We offer two primary GERD treatment procedures with excellent safety and efficacy profiles that can dramatically improve or permanently fix reflux. The first is the LINX reflux management system, which essentially places a titanium bracelet around the LES, reinforcing it with added pressure yet allowing liquids and solids to pass through. The operation is performed laparoscopically or robotically, and it is often an outpatient procedure.

Some patients may be more suited to a traditional surgical fundoplication, which involves wrapping the stomach around the lower part of the esophagus to achieve the same reinforcement as we mentioned above with the LINX. This procedure uses sutures to hold the stomach in place and requires more recovery time but has a similar safety and efficacy profile.

You can learn more about the similarities and differences between LINX and fundoplication here.

Next Steps

Most importantly, addressing any chronic acid reflux issues is of paramount importance. Along with the discomfort that chronic reflux brings is the increased risk of a pre-cancerous condition called Barrett’s Esophagus, where the cellular lining of the esophagus becomes more like the stomach to accommodate the constant wash of erosive juices. This can eventually lead to esophageal cancer, which has also been on the rise. Some patients can also experience esophageal stricture due to inflammation caused by the irritation of gastric juices on the esophageal lining.

Contact us to schedule a consultation with one of our surgeons to learn more about the non-surgical and surgical options available, depending on the degree and severity of your GERD issues. It’s also worth noting that if you are experiencing severe GERD and you are obese, you may wish to consider a gastric bypass, which not only helps you lose weight but is highly effective in improving or resolving gastric reflux.