What Is a Proton Pump Inhibitor?

Proton pump inhibitors (also known as PPIs) are among the most commonly prescribed gastro protective drugs in the UK. In simple terms, a PPI acts by blocking the production of hydrochloric acid in the stomach, which helps to treat conditions caused by the presence of excess acid production. Examples of such conditions include gastritis, peptic ulcers and gastro-oesophageal reflux disease (GORD) often associated with Helicobacter Pylori infections.

There are also some situations in which a protective effect on the gastric mucosa is necessary, such as when taking non-steroidal anti-inflammatory drugs (NSAIDs) to treat pain and inflammation. 

One of the most common side effects of these types of drugs is that it increases the production of stomach acids, leading to irritation and discomfort. Therefore often a PPI such as Lansoprazole or Omeprazole is taken alongside to help regulate the levels of stomach acid. 

PPIs are a very effective treatment choice in some instances, but do come with their own potential risks with continual use. Taking a proton pump inhibitor for a long period of time; (a year or more) is associated with an increased risk of hip, wrist, and spinal fractures, an increased risk of kidney disease, a higher frequency of infections such as pneumonia or an intestinal infection caused by the bacteria Clostridium difficile and with a decrease in the absorption of nutrients such as vitamin B12, iron or magnesium, a mineral necessary in many functions of our body.

PPIs can also reduce the effect of other commonly prescribed drugs, such as oral anticoagulants, clopidogrel, benzodiazepines, or levothyroxine.

What are proton pump inhibitors used for?

PPIs are typically prescribed for the treatment of conditions caused by increased acid secretion within the stomach, including:

• – Stomach or duodenal ulcer.
• – The eradication of the Helicobacter pylori bacteria.
• – Gastro-oesophageal reflux disease (GORD), including Barrett’s disease.
• – Zollinger-Ellison syndrome, caused by tumors.

Other situations in which these drugs may be used, is to prevent gastric mucosa lesions when starting treatment with non-steroidal anti-inflammatory drugs (NSAID’s). In these cases, it should also be prescribed by a suitable healthcare professional who will assess, whether or not it is necessary to take one of these drugs together with the prescribed medication, based on a series of factors such as:

• – Age 
• – If there is a history of stomach or duodenal ulcer or upper gastrointestinal bleeding.
• – Or in the case of simultaneous treatment with other drugs that can affect the stomach lining: antiplatelet drugs such as aspirin, anticoagulants, corticosteroids, or selective serotonin reuptake inhibitors (a type of antidepressant known as SSRI’s).

Can I take gastro-protective drugs during pregnancy?

The most common PPI treatment used in pregnancy is Omeprazole. Clinical evidence suggests it is not known to be harmful to the foetus. 

No clear guidance is available to support the safety of other PPI drugs to be used during any stage of pregnancy, and therefore is not recommended.

How do proton pump inhibitors work?

The proton pump inhibitors will specifically inhibit the enzyme H⁺ / K⁺ ATPase, known precisely as a proton pump, present on the cells lining the stomach and delegated to the production of gastric juices (gastric parietal cells). This inhibits the last step in producing hydrochloric acid in the stomach. This dose-dependent inhibition affects both fasting (or basal acid) and food-induced secretion.

These are converted into their active form only once they arrive in the gastric parietal cells. Gastric acid secretion only starts again when new H + / K + -ATPase molecules are produced and released. 

In this way, although proton pump inhibitors can “survive” in the blood for only two hours at the most, acid secretion is inhibited for a longer time (typically 24-48 hours). For this reason, proton pump inhibitors are known as ‘pro-drugs’. This means they are activated only in an acidic environment.

How long can you take proton pump inhibitors?

If you are buying PPIs over the counter in a pharmacy, the MHRA (medicines and health regulations authority) recommends the period of treatment should usually be around two weeks (or less in some cases) to treat heart-burn or acid reflux, or as preventative cover alongside short-term NSAID use.  

PPIs can be prescribed by a doctor for medium to long-term use for other indications, but is usually not recommended for use longer than 8-weeks. This depends on the condition being treated, and doctors may prescribe this drug for an extended period. 

How should you take a PPI drug?

• – Take the capsules in the morning, preferably on an empty stomach, whole, without chewing or crushing them, with half a glass of water.
• – Do not exceed the treatment dose prescribed by your doctor.
• – Continue treatment only for as long as symptoms are present. 

Are Proton Pump Inhibitors Safe Drugs?

PPIs are fully licensed and regulated by the MHRA for use in the UK.

Like all medication, PPIs can have side effects, especially after prolonged use.

If you are using a PPI for the first time, an extremely rare but serious side effect to look out for is anaphylaxis. This type of reaction is often immediate (usually within 5-10 minutes of taking the medication), but needs urgent medical attention if it occurs. 

Most short-term side effects are usually transient and reversible, such as:

• – Headache
• – Diarrhoea
• – Skin rashes

PPIs can also have other effects on the body, such as affecting absorption (and consequent deficiency) of vitamin B12, magnesium, and calcium, all of which are important for the musculoskeletal system. 

Malabsorption of certain vitamins and minerals are often seen in those using PPI over medium to long periods of time (more than 8-weeks).

In particular, people at most risk include those with osteoporosis, as this can increase the risk of bone fractures. Furthermore, by changing the pH of the stomach, they can promote the development of intestinal infections, such as those caused by Helicobacter Pylori or Clostridium Difficile. These infections are quite dangerous because they can lead to tumors in the stomach or intestines.

The use of proton pump inhibitors is contraindicated in some situations, such as:

• – If you suffer from liver problems (liver failure);
• – In case of known allergy to the PPI itself and one or more of the other components of the medicine (other active ingredients and excipients), that must be used. Generally, the use of these active ingredients is contraindicated even in cases of known allergy to other proton pump inhibitor drugs within the same group.
• – PPIs can have interactions with other drugs if they are either taken together or within a short period of time. In particular, they can interfere with the metabolism of antifungals, anticoagulants, antiepileptic drugs, antidepressants, antibiotics and certain cardiotonic drugs.

Which medications are proton pump inhibitors?

Drugs in this category include:

• – Omeprazole
• – Pantoprazole
• – Lansoprazole
• – Esomeprazole
• – Rabeprazole.

What is the difference between omeprazole and lansoprazole?

There is no significant difference in the level of effectiveness of both Lansoprazole and Omeprazole in managing acid reflux and heartburn. Omeprazole has shown to be more effective at minimizing gastric acidity compared to Lansoprazole. The other difference is linked to their dosages. Lansoprazole requires a smaller daily dose to treat certain conditions effectively. 

Are proton pump inhibitors available over the counter? 

Popular proton pump inhibitors such as omeprazole, lansoprazole, and esomeprazole are sold as over-the-counter drugs to prevent heartburn or reflux. These are intended for short-term use only. If you require a PPI for longer than two weeks, you should speak to a doctor regarding your condition.