Proton Pump Inhibitors

[PhilGM]

I note from posts that many of us are given stomach medications ostensibly to “ to protect the stomach”. In fact these PPI’s, omeprazole, lansoprazole, etc. act on the liver to reduce the amount of acid produced. In my case they induced fundic polyps to form on the stomach lining and I had to discontinue them. Incidentally a new cardiologist discontinued my clopidogrel leaving aspirin as my only blood thinner. Now a new trial has questioned the use of aspirin finding it ineffective in outcomes and causing increased internal bleeding. What are everyone’s thoughts on this.

[Heythrop51]

Have you any references for these statements? Thank you.

[PhilGM in reply to Heythrop51]

I was advised by my gastroenterologist that polyps were a possible side effect of PPI’s and sure enough two years later a gastroscopy confirmed that I had developed them, think the drug notes confirm this is a possibility. Can’t find the article I read re aspirin but there are plenty of negative as well as positive trials. Just wanted to know what folk better informed than me think!

[Lezzers]

I have heard aspirin can cause stomach ulcers, my husband was taking 150mg for almost 20 years & now takes 75mg. He's never had any problems but he religiously eats breakfast before taking it.

[daveofpensby]

I was on Aspirin from 1994 the date of first HA until 3 months after 2nd HA in August 2018 no other medication never had any problem with my stomach Everyone is different

[Dickyticker26]

In my case aspirin caused me to urinate long strips of black blood and I am now put down as being allergic to it

[Sarahd56]

OMG!!!

[Janma123]

After my husbands first HA in 2007 he was prescribed both clopidogrel and 75mg aspirin. The aspirin caused bad stomach pain (at the time he didn’t eat breakfast) so he was taken off it and prescribed omeprazole for his stomach. The omeprazole prescription was continued ‘to protect his stomach’ and he continued to take it for 11 years. Metformin was added into the mix during those years. The clopidogrel was changed for Aspirin when it was discovered that omeprazole reduces the effectiveness of clopidogrel!

During 2017 he developed a few issues with memory, balance and tiredness and was prescribed folic acid for a couple of months. Fast forward to 2018 - second HA, CABGx4, change of anticoagulant to rivaroxaban and aspirin, continue with the omeprazole. Following a stroke 8 weeks post-op, now on Edoxaban and continue with the omeprazole.

After his HA and stroke he was struggling with a number of issues (the stroke unit he was in were looking at dementia as a possibility), his folic acid went low again, he was tired, had tinnitus, had poor balance, his memory and aphasia were getting worse, his mood was awful. He was then diagnosed with vitamin b12 deficiency and prescribed injections - the first few made little difference but once the folic acid and vitamin d3 were added - what a difference! He still has a way to go but is totally different from the person he had become, who had no energy and was convinced that I was colluding with his doctors to kill him off!!

We were given no information on b12 deficiency but my research on the NHS site which lead me to healthunlocked gave me a wealth of information. PPIs reduce stomach acid production which means the body is unable to extract b12 from food and can therefore over time become deficient! Add metformin into the mix which affects absorption of nutrients from the diet (not just sugars) and you are building a problem! Patients with long term PPI prescriptions and metformin prescriptions are supposed to be monitored for b12 but often are not. The list of b12d symptoms and effects are available on the Pernicious Anaemia forum and are worth checking out!

Sorry for the long post but it was a long slow and frightening development over several years.

PLEASE everyone on PPIs long term and metformin ask you doctors to test your b12 folate and d3 levels.

[MandLB in reply to Janma123]

Thank you for such a detailed post. Very useful. My husband is on metformin and gliclazide for his diabetes and has been taking omeprazole for several months because he had severe inflammation of the oesophagus causing refluxing and vomiting. I say 'had' because the omeprazole has really done the trick and he's much better.

But your post makes clear that we need to keep a close watch on his vitamin levels. He recently had a bad break in his leg and it was then found that he has early stage osteoporosis. Looks like vitamin D deficiency has already started.

I'll have to look into this a bit further.

[Rosei]

I was put on 75mg of Aspirin after my heart attack along with the usual statins etc. First I developed an allergy to statins, it did something horrible to my liver, then the Aspirin got me, after a colonoscopy and gastroscope I was diagnosed with Lymphocytic Colitis, now I am on Clopidogrel, so far no side effects,

[jerry12953]

I was prescribed Omeprazole for heartburn/acid reflux but after a while I realised that if my heartburn was particularly bad I could take one tablet (or maybe two or three) and it would control it. Then back to taking gaviscon as required.

Not sure if that was relevant to your situation but that's my experience.

[peterfromlondon in reply to jerry12953]

hi that very interesting , do u have the ppi every day ? antacid tablets do help but when its bad its awful !

[jerry12953 in reply to peterfromlondon]

My heartburn predates any actual heart symptoms by quite a few years. If I understand your question correctly, i either

a) make do, or

b) take gaviscon - usually at night, or

c) if I've eaten something particularly rich, spicy or unusual (eg meat) the gaviscon isn't enough and I take one omeprazole tab. Usually that will be enough to settle it down, if not I take another 24 hours later and that usually does the trick.

Hope that helps!

[PhilGM in reply to jerry12953]

Thanks Jerry, so you take your ppi when necessary rather than on a regular basis which is what my wife does, GP seemed a bit non plussed when a known side effect actually materialises! Do you take a aspirin which I am loath to do with my stomach flare up?

[jerry12953 in reply to PhilGM]

Yes, that's right, it was prescribed to me for long term use but I realised I just didn't need it, and it does have side-effects long-term......

I do take aspirin, and I believe my acid reflux is slightly worse with it but I'm just getting on really......

Just try it and see if it works for you!

[BillyMct]

A long time ago prior to any cardiology issues were identified I was on long term PPI treatment which became ineffective , my GP at the time wasn't any help stating I was on the correct treatment. So i researched alternative natural options after a period of experimentation I found sweet red apples were the remedy my stomach needed for acid reflux. Ideally one sweet red apple a day keeps the symptoms in check and have done for the many years since I stopped the PPI (omeprazole) . I find the sweeter and juicier the better and sour or green apples seem to have the opposite effect. HTH. I also found any high fat content pastry was a immediate trigger for acid reflux though at the time I wasn't on a warning to avoid such foods ie no heart issue diagnosis I also stopped consumption of that food type to give the "an apple a day keeps the doc away "remedy an easier path to success.

[Platypus6 in reply to BillyMct]

What brand are the apples?

[BillyMct in reply to Platypus6]

I tend to get royal gala which are small sweet red ones . for me at least they need tobe sweet and juicy. I was an avid apple avoider prior to this and prefer fruit in citris form . I do have to make a mental effort to keep up with the one a day intake and there is a noticeable rise in acid reflux if I have abstained (from apples) for a while. Its not a perfect solution as there are some days where I can get reflux despite having being a regular apple eater but it better for me than being on omeprazole and still having issues

[Platypus6 in reply to BillyMct]

I have added them to my shopping list, will definitely give them a try, any help would be great thanks.

[Platypus6 in reply to BillyMct]

I would love an apple to help my acid reflux instead of meds.

[Rbrealey in reply to BillyMct]

Apples also work for me! I have the Pink Lady ones which are sweet and juicy. I never made the connection until now but it’s absolutely true!

[Jacey15 in reply to BillyMct]

Apples make mine worse 😕

[Dockdog]

Hi Phil,

I was prescribed a PPI when first diagnosed with Pericarditis but I have a healthy mistrust of too much medication and I found the right diet to restrict the acid reflux as well as using probiotic capsules which really calmed things down in my gut. As to the 75mg aspirin which I take daily post pericardiectomy, it has never been an issue and I am a strong advocate of aspirin over paracetemol for light to medium pain. The negatives are more than outweighed by the positives to my belief and recent studies on aspirin are indicating great benefits on bowel and gut cancer prevention. I guess you have to find what suits you best as an individual and wish you all the best for a healthy future.

[PhilGM in reply to Dockdog]

Thank you Dockdog, so interesting to learn other people’s experiences of the drugs we take!

[Qualipop]

I was on clopidogrel and aspirin. I'm allergic to PPIs so was given Ranitidine instead but I was still getting severe stomach pain ( I have had peptic ulcers in the past) so my GP stopped the clopidogrel after 6 or 7 months saying aspirin is better known; the side effects are better known and how to treat them. Not sure which was causing the most problems but I'm still getting bad stomach pain at times with just aspirin. A friend's husband has been on aspirin for about 30 years after a very severe heart attack. He recently had two haemorrhages from his bowel but they have insisted he stays on the aspirin.

[MountainGoat52]

My understanding is that current thinking is that aspirin is only worthwhile for those that have had a cardiac event and then only in small quantities. I was prescribed 75mg after my HA. My brother has problems with aspirin upsetting his stomach and so takes a coated tablet.

As for PPIs, I cannot comment as I cannot tolerate them. I therefore take all my medication with a decent bowl of cereal in the morning.

[Forumuse]

Hi PhilGM, I’m relatively new to all this medication, but am one of those patients who seem to have suffered adverse side effects from proton pump inhibitors. I was switched from lanzopremole to omeprazole, but the stomach upset is back. I’m on tricagelor and aspirin for blood thinning for a year, so worry that I will need some protection for my stomach lining, but the PPIs so far just aren’t working for me.

I’m on dual platelet therapy specifically because I’m not suited for stents or bypass - my heart attack was as a result of a split in my arterial wall. Is there any alternative to PPI?

[PhilGM in reply to Forumuse]

Hope someone better qualified than I will have some ideas and you should of course consult your GP. I tried Ranitidine and Gaviscon and got some relief but PPI’s seem to be the GP’s drug of choice. When I was diagnosed with polyps I stopped taking them as the discomfort had abated until recently. Some people seem to have some success with diet and you may wish to research this. Did you have stomach discomfort before you had the heart meds as I did? If not it seems likely that they are causing the upset so your doctor needs to find a solution. Note that PPI’s work by reducing the amount of acid available in the stomach and therefore also lessening any potential bad effect it has on the lining. Not sure myself if this constitutes protecting the stomach but it seems to work judging from the number of people taking them long term.

[Miyim]

I took Omeprazole for about 20. Years for suspected IBS and a hiatus hernia. Never checked for deficiencies in anything or for complications despite my enquiries. Following a heart attack last year this was changed to Lanzopremole because it didn’t affect the Clopidogeral . This resulted in severe diarrhoea for 3 weeks, completely ignored by the cardiac specialist. Fortunately my GP moved me onto Ranitidine and life is good. I was suffering from memory and balance problems for some years previously, partly reduced by the introduction of folic acid that I now take daily. Now my memory, balance etc are back to normal. I also take the daily aspirin after forcing myself to partake of a small breakfast every day. Clopidogeral due to end in 2 weeks and I confess to being nervous but time will tell. As far as the IBS and reflux are concerned hey are virtually gone due in most part to a compete change in diet started a few months before my heart attack and I would encourage anyone with these problems to seriously explore this as an option. I joined Slimming World to get my weight under control and now am not only 5 1/2 stone lighter but virtually symptom free whilst having done no calorie counting or giving up on potatoes, pasta or rice! However, any fat I now eat is carefully regulated, along with sugar and I noticed the change within a matter of months. Hope that may be of use to someone as proton pump inhibitors are best avoided when at all possible.