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How do proton pump inhibitors (PPIs) treat GERD?

Lawrence S. Friedman, MD
Gastroenterology
Proton pump inhibitors (PPIs) are more effective than H2 blockers or antacids for lowering the production of gastric acid in the treatment of gastroesophageal reflux disease (GERD). PPIs work by inactivating a specific enzyme responsible for the final step of acid release in the stomach. They can reduce gastric acid secretion by more than 95% without causing systemic side effects. However, many people experience "acid rebound" after they stop taking these medications, a condition that can be controlled by tapering off the drug slowly or switching to a H2 blocker medication once the course of PPI medication is complete.

PPIs available without prescription include lansoprazole (Prevacid) and omeprazole (Prilosec). PPIs available by prescription include rabeprazole (Aciphex), pantoprazole (Protonix), omeprazole (Zegerid), esomeprazole (Nexium), and dexlansoprazole (Dexilant). Omeprazole, sold as Zegerid, is an immediate-release medication, in contrast to the others, which are delayed-release.

Although they have numerous advantages, PPIs are expensive. In addition, they may make the gastrointestinal (GI) tract more susceptible to bacterial infections and vitamin B12 deficiency, and may increase the long-term risk of hip fractures. In addition, there has been some controversy over whether PPIs may interfere with the blood-thinning medication clopidogrel (Plavix). Despite these concerns, PPIs have become the preferred medication for reflux esophagitis and for patients with unremitting GERD-derived respiratory symptoms. Doctors often recommend them first for frequent, uncomplicated heartburn, but once symptoms recede, a less expensive medication such as an H2 blocker can be effective.

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Important: This content reflects information from various individuals and organizations and may offer alternative or opposing points of view. It should not be used for medical advice, diagnosis or treatment. As always, you should consult with your healthcare provider about your specific health needs.