Proton pump Inhibitors – Part 1

Proton pump Inhibitors

4 part series on Acid Reflux

Part1: Your Questions answered on PPIs

• What are the differences between proton pump inhibitors?
• Do they all have the same side effect profile?
• If I experience side effects from one, will I experience the same effects if I try another?

Proton pump inhibitors (PPIs) are the most commonly prescribed class of medication for the treatment stomach acid-related disorders and heartburn. PPIs block parietal cells from acid within the stomach.

There are millions of parietal cells within the stomach, and they are constantly reproducing. For this reason, complete block of acid production is not possible, this would explain why these drugs have such a high safety rate.

However, as with any other drugs, side effects can occur, some users are more prone to side-effects than others. This will be discussed later.

There are a number of PPIs available. The chemical structure of all PPIs are very similar, however, it is worth noting that very few studies comparing these drugs to each other are available.

All PPIs heal oesophagitis in 90–94% of patients. There appear to be no significant differences in overall healing and symptom improvement rates between different PPIs.

Omeprazole and lansoprazole have been available the longest. Both Omeprazole and Lansoprazole are immensely popular choices with doctors and patients, some of these PPIs are available over the counter (OTC).

While the newer PPIs such as rabeprazole and pantoprazole have some clinical studies supporting greater acid suppression compared to omeprazole, these differences do not appear to be clinically important.

In terms of administering the medicines, rabeprazole and pantoprazole are smaller and may be better suited to those who have swallowing difficulties. Esomeprazole (Nexium), is a relatively new and extremely powerful PPI, it was first approved in 2001.

When compared to Placebo in clinical trials, it has been shown that PPIs has a higher rate of certain reported side-effects. Headache, abdominal pain, bloating, diarrhoea and nausea have all been reported and they occur in approximately 1-2% of people taking PPIs.

There is no scientific data or guidelines presented to help doctors make the decision on which PPIs to prescribe. The relatively few patients who report side-effects are best managed by switching to alternative PPI.

It has been shown that that you may not get the same side-effects when you switch PPI. The only exception to this is allergic reaction.