Regarding the issue of discontinuing the use of proton pump inhibitors (PPIs) for gastroesophageal reflux disease (GERD)?
Hello, Doctor.
I underwent an endoscopy at the Taipei Hospital of the Ministry of Health and Welfare around December 30, 2016.
Following that, I regularly took PPI medication for disease management, specifically Dexlansoprazole 60 mg.
Additionally, I was prescribed Domperidone 10 mg (before meals) and Kascoal 40 mg (after meals).
My attending physician instructed me to take the PPI before breakfast.
The medication effectively controlled my condition, and I experienced almost no severe heartburn symptoms that I had before starting the treatment.
However, in early April 2017, I ran out of the PPI medication, and my physician did not prescribe a new supply for me to continue.
Since then, I have gradually started to experience heartburn, nausea, loss of appetite, and even diarrhea.
Should I return to the hospital for another endoscopy? Is it necessary to use PPI medication to effectively suppress these symptoms? I have also come across some information online stating that "PPIs can effectively reduce symptoms but do not cure the underlying condition, and they can lead to dependency and side effects," as well as "PPIs only control symptoms without addressing the root cause, making it easy to develop a reliance on the medication, which is difficult to discontinue." Are these statements accurate? I am quite worried after reading this, and I kindly request your response.
Thank you!
A Yi, 20~29 year old female. Ask Date: 2017/04/08
Dr. Cai Anshun reply Gastroenterology and Hepatology
Hello: Essentially, PPIs (proton pump inhibitors) suppress gastric acid secretion and should not be used long-term, as they may affect digestion, bacterial balance, and calcium absorption.
For gastroesophageal reflux disease (GERD), it is recommended to improve lifestyle and dietary habits; otherwise, symptoms may easily recur after discontinuation of medication.
It is advisable to reduce the intake of tea, coffee, carbonated beverages, chocolate, sweets, glutinous rice products, and high-fat/high-protein foods.
Avoid overeating, smoking, drinking alcohol, chewing betel nut or gum, and managing stress, as well as addressing issues related to being overweight or underweight.
If symptoms do not improve, a follow-up with a gastroenterologist may be necessary to evaluate the need for endoscopy or to consider switching to H2 receptor antagonists (such as cimetidine, etc.).
Changhua Hospital cares about your health.
Dr.
Tsai An-shun.
Reply Date: 2017/04/08
More Info
When it comes to the management of gastroesophageal reflux disease (GERD) using proton pump inhibitors (PPIs), it is essential to understand both the benefits and potential drawbacks of long-term use. Your experience with Dexlansoprazole and the subsequent symptoms you are experiencing after discontinuation of the medication raises several important points regarding the treatment of GERD.
Firstly, it is well-established that PPIs are highly effective in reducing gastric acid secretion, which helps alleviate symptoms of GERD, such as heartburn and regurgitation. They work by inhibiting the proton pumps in the stomach lining, leading to a significant decrease in acid production. This mechanism not only provides symptomatic relief but also promotes healing of the esophagus and stomach lining, especially in cases of erosive esophagitis or peptic ulcers.
However, your observation that symptoms have returned after stopping the PPI is not uncommon. GERD is a chronic condition, and many patients experience a recurrence of symptoms upon discontinuation of acid suppression therapy. This phenomenon can be attributed to the underlying pathophysiology of GERD, which may include factors such as lower esophageal sphincter dysfunction, increased gastric acid secretion, or delayed gastric emptying. Therefore, it is not unusual for patients to require ongoing treatment to maintain symptom control.
Regarding your concerns about the long-term use of PPIs, it is true that there has been some debate in the medical community about the potential risks associated with prolonged PPI therapy. Some studies have suggested that long-term use of PPIs may be associated with certain adverse effects, including an increased risk of gastrointestinal infections, bone fractures, kidney disease, and vitamin B12 deficiency. However, these risks are generally considered to be low in the context of appropriate use, and the benefits of symptom control and esophageal healing often outweigh these potential concerns.
The notion that PPIs do not address the root cause of GERD is also valid. While they effectively manage symptoms, they do not correct the underlying anatomical or physiological issues that contribute to the condition. This is why lifestyle modifications, such as dietary changes, weight management, and avoiding triggers (like smoking and alcohol), are also critical components of GERD management.
As for your question about whether you should return for another endoscopy, it would be prudent to consult your healthcare provider. An endoscopy can help assess the current state of your esophagus and stomach, especially if you are experiencing new or worsening symptoms. It can also rule out other potential causes of your symptoms, such as ulcers or malignancies.
In summary, while PPIs are effective for managing GERD, they may not be suitable for everyone in the long term. It is essential to have a comprehensive treatment plan that includes both medication and lifestyle modifications. If you are experiencing a resurgence of symptoms, it is advisable to discuss this with your healthcare provider, who may consider reinitiating PPI therapy or exploring alternative treatment options. Remember, managing GERD often requires a tailored approach, and ongoing communication with your healthcare team is vital for optimal care.
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