The Problems With Heartburn Medication: PPIs, Antacids, & H2 Blockers

If you are one of the millions of Americans who struggle with heartburn regularly, you may be battling something called gastroesophageal reflux disease (GERD). If this diagnosis is already familiar to you, your doctor may have prescribed preventative treatments like proton pump inhibitors (PPIs) such as Prilosec, Nexium, or Prevacid. H2 blockers are also common: Pepcid and Zantac. Many patients will also find that they need an antacid for bad days or attacks after eating trigger foods; antacids include calcium carbonate in brands like Tums, Pepto Bismol, and Rolaids.

However, if you’ve ever read the labels on these medications, you may have noticed that they don’t recommend use for longer than a couple of weeks; patients can use some for upwards of a month. Furthermore, long-term use of some of these medications can have some serious side effects.

Proton Pump Inhibitors

How Do PPIs Work?

Within the stomach’s lining are tiny cells called parietal cells, and these cells contain tiny structures called proton pumps. These pumps have one highly important job in the stomach: the secretion of pure acid in the form of H+ or protons. Since many patients’ main complaint with GERD is a feeling of high acidity, a common remedy to this would be to reduce the stomach’s acidity, right? This is what PPIs do— they block and slow down the production of hydrochloric acid that enters the stomach.

What’s the Problem With PPIs?

First and foremost, PPIs do have some utility— mainly for patients with ulcers that need to heal. However, GERD is an inappropriate application of PPIs as it doesn’t address the root cause of the problem: a weakened lower esophageal sphincter (LES). In fact, none of the medications commonly prescribed for GERD help you in the long run.

We don’t recommend that you continually take PPIs for a few reasons. They can decrease your body’s absorption of magnesium and calcium, and they can increase your risk for developing infections like Clostridium difficile and pneumonia.

Antacids

What Are Antacids?

Antacids work on a similar principle: reduce the amount of stomach acid, and your heartburn will cease. While this logic is entirely sound, we’re only just now starting to question what other issues low stomach acid is causing. Antacids do precisely what their name suggests: they reduce acid as you take them. The main ingredient in antacids is calcium carbonate, a salt produced from a strong base and a weak acid; this unique formula means that calcium carbonate is slightly basic and can react with the stomach’s acid and reduce its acidity.

Why Shouldn’t I Use Antacids?

Again, since antacids reduce the acidity (and increase the pH) of the stomach’s contents, malabsorption can occur— just as with chronic PPI use. Unfortunately, antacids also have another scary potential: calcium overdose. If you take a peek at the back of a container of Tums, there is a daily recommended limit that you should not exceed. 

Usually, antacids are marketed as being completely safe to take whenever you have symptoms. However, some patients may find that the stomach enzyme pepsin causes their symptoms— not the acid. These patients tend to take more antacids than they should, as pepsin doesn’t break down until the pH reaches around 8. This can be a dangerous loop to get stuck in, making the risk of calcium overdose very dangerous.

H2 Blockers

What Is an H2 Blocker?

These medications reduce stomach acid by blocking the signaling of parietal cells through histamine binding. There are three different mechanisms in the parietal cells for signaling the increased production of hydrochloric acid; one of these mechanisms involves histamine (a tiny molecule typically involved in immune and inflammatory actions). Simply put, there is a dimmer switch in the parietal cells that reacts with histamine. H2 blockers essentially dim this switch by blocking this pathway, and minimal hydrochloric acid can be produced by that cell.

What’s the Problem With H2 Blockers?

If you had to choose between long-term PPI use or long-term H2 blocker use, the H2 blocker would be the safer bet. H2 blockers reduce stomach acidity to a much lesser extent while maintaining the stomach’s ability to react to internal stimuli and change the acidity as needed. However, this still begs the question: shouldn’t we solve the leaky LES in the first place? There’s no need to be on medication chronically, especially one that alters the proper function of an organ. The stomach is meant to be an acidic place; when we disrupt this, we also disrupt processes down the line.

The Alternative To Heartburn Medication

Here at the Tampa Bay Reflux Center, we know what a struggle consistent heartburn is. If you’re losing sleep over reflux attacks in the middle of the night without preventative medication, it might be time to consider a more permanent option. Schedule a consultation with our reflux specialists today; we offer three different types of reflux surgery that can help you get your life back!