PPI long term use

[nuttytreacle]

Hi, I am nearly 5 years post Ivor Lewis and have been on esomaprazole since my op, I've  now read in the news that they can increase the risk of kidney and heart  disease plus dementia! Concerned  about this of course, I'm seeing  my consultant  in August  and will ask him, but wondered  what people thought .

[Mulomulo]

Do u take the ppi in the morning?  I was told that we should take in the morning so that our body movements help reduce the long term side effects

[Danko in reply to Mulomulo]

I take mine in the morning. Thankfully I rarely have problems with reflux these days and I was thinking of seeing if I could manage without them.

[Mulomulo in reply to Danko]

Do tell me what the doc says. Mine has told me taking 1 pill a day is fine. My 1 pull is 20mg

[Danko in reply to Mulomulo]

I will be seeing my consultant at the end of June and will let you know what he says. I'm also on 20mg per day

[margie1]

Hi 

I take one in the morning and one at night I've not seen the article on taking ppi's 

[drsteve]

PPIs were meant to be used short term, never long term. Please see livingwithachalasia.org and download my book for free.

[Hidden]

PPIs switch off stomach acid, so if you have had surgery like an oesophagectomy that removes the lower oesophageal sphincter, and you still have a stomach that produces acid, you will very likely need to take PPIs or some equivalent to reduce the risk of any damage to your remaining oesophagus from the reflux.   That is probably the priority, coupled with the unpleasant experience of reflux itself.   PPI medication is well established, is regarded as safe by the medical world and is frequently used to reduce acid to resolve digestion / reflux problems in the short term.

All medication has some side effects, and with long term use of PPIs there is an issue about how calcium gets absorbed into the system because stomach acid does this as part of its normal job.   So some people do get concerned about calcium absorption.   If this applies one can get a bone density scan, and of, required, iron / B12 / calcium supplements.   You may have an absorption problem more generally anyway with a shortened digestive system, so having check ups on your mineral / vitamin levels is a good idea.

Long term PPI use can affect the balance of bacteria in your gut and might make you more liable to small intestine bacterial overgrowth (causes persistent diarrhoea).   This is something that has to be tackled with antibiotics.

The recent publicity about kidney damage has to be kept in proportion.   As I understand it, it was a large study, but there may have been an issue with its older age profile, and there would have been very few people who had an oesophagectomy in the study, and they may have had other issues as well.   As with any medication taken long term, it is always prudent to review things with your doctor.   I believe many regard significant problems with PPI as involving only a tiny proportion, and the assessment has to be judged against your own history and surgery.   The many thousands of people who take PPIs are usually taking them for reasons that are concerned with other digestive problems than the effects after oesophagectomy surgery, and it is possible that some patients may have been on PPIs for too long anyway, when perhaps they should have been more thoroughly investigated for underlying causes.

Some people do wean themselves off PPIs.   Some have done this successfully;  others find they still need them.   There is also some value in the time of day when they are taken I believe.  

But you are sensible to discuss this with your doctor in due course who, unlike me, is medically qualified and knows your history.

[haward]

At a recent OPA meeting the surgeon presenting was asked about PPIs and his view was that most of us would be on them for the rest of our lives; for the same reason that Alan gives.