A leading GP has admitted she now advises her own patients to come off heartburn drugs as soon as possible, warning that long-term use of the medicines carries risks including bone fractures, vitamin deficiencies and a possible link to dementia.
Dr Philippa Kaye, a GP, author and broadcaster, said the drugs, known as proton pump inhibitors or PPIs, are among the most popular medicines in the world and include omeprazole, lansoprazole and esomeprazole. They are prescribed for acid reflux, a condition that causes stomach acid to rise into the throat, and are also given to patients on long-term anti-inflammatory tablets to protect against dangerous stomach bleeds.
"I now tell my patients to stop taking them as soon as possible," Dr Kaye said, adding that the tablets "were never designed to be taken long-term". Yet studies show that 40 per cent of patients take PPIs for at least a year, and a tenth take them for five years or more.
Acid reflux affects more than six million people in Britain, according to Dr Kaye. It occurs when stomach acid leaks into the oesophagus and throat, causing a burning sensation, discomfort and chest pain that can disrupt sleep.
What causes heartburn
Heartburn happens when the ring of muscle at the bottom of the oesophagus fails to close properly, allowing acid from the stomach to flow back up into the gullet. This produces the burning sensation behind the breastbone and a sour taste in the mouth, and explains why symptoms are often worse after eating, lying down or bending over. Over time, the acid can inflame the lining of the oesophagus, raising the risk of oesophageal cancer.
PPIs work by switching off the tiny pumps in the stomach lining that produce acid, reducing how much is made and giving the oesophagus lining a chance to heal. Used in short bursts, Dr Kaye said, the drugs can be "miraculous" in ending the suffering of heartburn patients.
Around ten million people regularly take omeprazole or similar drugs, at a cost to the NHS of about £300 million a year.
The risks of long-term use
Dr Kaye said research shows that patients taking PPIs long-term are more likely to develop deficiencies in vitamin B12, magnesium and iron, all of which can cause fatigue and weakness. They also face a greater risk of chronic kidney disease, an irreversible and potentially deadly condition, as well as bone fractures, certain infections and, on rare occasions, gastric cancer. Some evidence suggests PPI users have an increased chance of developing dementia, though Dr Kaye said more research is needed to prove the link.
How to quit PPIs for heartburn
Dr Kaye said losing weight, for those carrying excess weight, has the strongest evidence base of any lifestyle change, since extra weight increases pressure in the abdomen and worsens reflux. Even a loss of five to ten per cent of body weight can significantly improve symptoms, she said.
Other triggers to avoid include large meals, eating close to bedtime, alcohol, caffeine, chocolate, fatty or spicy food and fizzy drinks. Stopping smoking, cutting back on alcohol and raising the head of the bed, so acid cannot travel back up during sleep, can also help, she said.
Dr Kaye stressed that patients should not stop taking PPIs suddenly, as this can make symptoms worse, and should instead come off them gradually with the help of their GP.
Patients on anti-inflammatory painkillers
Not all PPI patients take the drugs for heartburn. Some are prescribed them alongside anti-inflammatory painkillers such as ibuprofen or naproxen for chronic pain conditions, because these drugs can irritate the stomach lining and trigger dangerous bleeds. Dr Kaye said some studies suggest most patients who take PPIs for a year or more are also taking anti-inflammatories.
She advised these patients to speak to their GP about lowering their dose of anti-inflammatories or taking them only as needed rather than daily, which could remove the need for PPIs altogether. Alternatives include paracetamol, which does not carry the risk of stomach bleeds, anti-inflammatory creams applied to the skin for joint pain, and physiotherapy exercises to manage pain without drugs.
However, Dr Kaye said not everyone can stop taking anti-inflammatories, and for those patients continuing PPIs is important, since the risk of a dangerous stomach bleed outweighs the risks of long-term use. For everyone else, she said, her advice is to come off PPIs as soon as it is safely possible.
