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Proton pump inhibitors (PPI)

Dr Karen Martin
Reviewed by Dr Karen MartinReviewed on 19.10.2023 | 4 minutes read

If you have not heard of the term proton pump inhibitors (PPIs), then you may have heard of some common examples, such as omeprazole, esomeprazole, lansoprazole, pantoprazole or rabeprazole.

They are a class of medication used to treat heartburn, and as protection if you are at an increased risk of stomach ulcers.

They work by reducing the amount of stomach acid that your body produces. PPIs are usually taken by mouth as a tablet, capsule, or liquid; however, in the hospital, you may receive one as an injection. Some PPIs require a prescription, but you can purchase esomeprazole, lansoprazole, and omeprazole from your pharmacy without a prescription.

Doctor’s advice

How do PPIs work?

PPIs work by reducing the amount of acid produced in your stomach. This acid is produced by a type of cell in your stomach called parietal cells. These cells produce stomach acid through proton pumps, a necessary step in the digestion of food. By inhibiting these proton pumps, proton pump inhibitors (hence the name) reduce the amount of acid in your stomach. This means less acid can enter the esophagus (food pipe) and cause symptoms such as irritation, heartburn, and coughing. When used for stomach ulcers, the reduction in acid helps your stomach lining to heal.

When should PPIs not be used?

PPIs should not be used to treat occasional heartburn as their effect builds up over time. They can take up to a week of daily use to get any benefit from them, so if you are looking for immediate relief from heartburn, antacids or Gaviscon maybe be better suited.

Who are PPIs for?

PPIs can be used by adults over 18 years to treat conditions such as heartburn and stomach ulcers, but are also used to protect the stomach against developing new ulcers. This is particularly for those people on nonsteroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen, naproxen, or diclofenac. When used for treatment of a stomach ulcer, a PPI may be combined with an antibiotic medication as part of the eradication of H. pylori, a bacteria that often causes ulcers.

PPIs are used for other conditions where stomach acid suppression is necessary, such as esophagitis, Barrett’s esophagus, and Zollinger-Ellison syndrome. They can be prescribed for children to treat these conditions; however, this is done under the close supervision of a doctor.

Should anyone not take PPIs?

It is best not to take this medication if you are pregnant, planning to become pregnant, or breastfeeding. It can be safe to do so but you should seek advice from your doctor before beginning treatment. This medication should also not be used if you have low magnesium, are at risk of developing osteoporosis, or have recently been suffering with diarrhea. Furthermore, do not use PPIs if you have previously had an allergic reaction to another PPI.

When would you use antacids over PPIs?

Choosing between antacids and proton pump inhibitors (PPIs) depends on the specific needs and symptoms of the individual. Here are some scenarios where antacids may be preferred over PPIs:

Mild occasional heartburn

Antacids are often sufficient for relieving mild, occasional heartburn symptoms. They work quickly to neutralize stomach acid and provide immediate relief. Individuals experiencing infrequent episodes of heartburn may find antacids more convenient and suitable for their needs.

Rapid relief

Antacids are known for their fast-acting nature, providing rapid relief from symptoms of heartburn and acid reflux. They can be taken as needed, making them suitable for on-the-go relief when symptoms occur unexpectedly.

Intermittent symptoms

If symptoms of heartburn or acid reflux occur sporadically and are not persistent, antacids may be preferred over PPIs. Using antacids on an as-needed basis can help manage occasional symptoms without the need for daily medication.

Short-term treatment

Antacids are often recommended for short-term treatment of mild to moderate heartburn or acid reflux symptoms. They are generally safe for temporary use and can be discontinued once symptoms resolve or improve.

Combination therapy

Antacids can be used in combination with other medications, such as PPIs, for additional relief of symptoms. This combination therapy may be beneficial for individuals with more severe or persistent symptoms who require stronger acid suppression, but would normally be recommended and prescribed by your doctor first.

Are there any side effects?

As with all medications, there are side effects; however, most people tolerate PPIs well. The common side effects of PPIs include headaches, nausea and vomiting, constipation, gas, and stomach pain. An important side effect to be aware of is that PPIs may reduce your absorption of magnesium, which is used by your muscles and may result in the development of muscle cramps.

PPIs may increase your risk of developing fractures as they can affect your calcium absorption, which is necessary for bone strength.

PPIs can increase your risk of a bacterial infection of the gut called C. diff and result in diarrhea that does not resolve after a few days. If these do occur, you should consult your doctor.

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This article has been written by UK-based doctors and pharmacists, so some advice may not apply to US users and some suggested treatments may not be available. For more information, please see our T&Cs.
Dr Karen Martin
Reviewed by Dr Karen Martin
Reviewed on 19.10.2023
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