Long-Term Use of Common Acid Reflux Medication Requires Monitoring, Doctor Warns
Millions of people rely on proton pump inhibitors (PPIs) like omeprazole to manage conditions such as heartburn, acid reflux, and indigestion. While these medications can provide significant relief, a growing consensus among healthcare professionals emphasizes the importance of careful monitoring, particularly with prolonged use. Dr. Punam Krishan, an NHS general practitioner and resident doctor on BBC’s Morning Live, recently highlighted potential risks associated with long-term PPI use, urging patients to discuss their medication with their doctor.
Approximately a quarter of adults in the UK experience acid reflux, often triggered by large meals. For those with persistent symptoms, PPIs are frequently prescribed to reduce stomach acid and alleviate discomfort. However, Dr. Krishan stresses that these medications are not intended for indefinite use and require regular medical review.
Understanding Acid Reflux and How PPIs Work
Acid reflux occurs when stomach acid flows back up into the esophagus, the tube connecting the mouth to the stomach. Dr. Krishan explained that the stomach contains acid essential for breaking down food. At the top of the stomach is a muscular valve, known as a sphincter, which acts as a barrier to prevent acid from escaping. “Its job is to basically seal the contents so the acid is not essentially tracking back up the food pipe, your oesophagus,” she explained. Factors like heavy meals and alcohol consumption can relax this sphincter, increasing the likelihood of acid reflux.
PPIs work by reducing the production of stomach acid. While highly effective, Dr. Krishan cautioned that long-term use can disrupt the natural balance within the gut and potentially lead to several adverse effects.
Potential Risks of Prolonged PPI Use
Dr. Krishan identified several potential risks associated with extended PPI use, including low magnesium levels, vitamin B12 deficiency, and an increased risk of gut infections, specifically Clostridioides difficile (C. Diff). “Essentially these medications aren’t there to be used unnecessarily or for a long period of time,” she stated. “They do require us to review them.”
C. Difficile is a bacterium that naturally resides in the gut, but PPIs can disrupt the gut’s microbial balance, allowing the bacterium to overgrow. This overgrowth can cause persistent diarrhea, a key “red flag” symptom that warrants immediate medical attention. Other symptoms of low magnesium can include muscle cramps, tiredness, and irregular heartbeat, while vitamin B12 deficiency can manifest as exhaustion, weakness, and neurological problems.
When to Seek Medical Attention
Patients experiencing any of these symptoms while taking PPIs should consult their doctor promptly. Specifically, a sudden onset of diarrhea or a change in bowel habits should be reported immediately. Regular check-ups with a GP are crucial for individuals on long-term PPI therapy to monitor for potential side effects and ensure the medication remains appropriate.
If you are taking omeprazole over the counter, it should not be used for longer than a fortnight. A doctor should be consulted if symptoms persist.
Alternative Treatments and Lifestyle Modifications
While PPIs can be highly effective, Dr. Krishan emphasized the importance of exploring alternative treatments and lifestyle modifications to manage acid reflux. These include eating smaller, more frequent meals, avoiding lying down immediately after eating, and propping up pillows to elevate the chest during sleep.
Certain foods can also exacerbate acid reflux symptoms. Keeping a food diary to identify personal triggers can be helpful. Dr. Krishan also recommended avoiding tight-fitting clothing, which can put pressure on the stomach. Gentle teas like chamomile and ginger tea may provide relief, while mint tea should be avoided as it can worsen reflux symptoms.
For persistent symptoms that don’t respond to lifestyle changes, a doctor may recommend further investigation, such as testing for Helicobacter pylori, a bacterium that can increase acid production, or a gastroscopy, a procedure involving a camera inserted into the stomach to examine the esophagus and stomach lining.
Frequency of GP Reviews
For those prescribed omeprazole for extended periods, doctors should carry out regular monitoring. Your GP will arrange a schedule for follow-up consultations tailored to your individual health requirements and risk factors, typically every six to 12 months. If omeprazole is recommended for more than a year, regular reviews become essential to minimize the risk of long-term adverse effects.
Dr. Krishan’s advice underscores the importance of a collaborative approach to managing acid reflux, involving open communication between patients and their healthcare providers to ensure safe and effective treatment.
