Proton pump inhibitors for gastroesophageal reflux disease (GERD)

These medications are available as time-release capsules that are taken orally once a day. Some of these drugs are given intravenously (IV) in the hospital.

Proton pump inhibitors reduce the production of acid in the stomach. This leaves little acid in the stomach juice so that if stomach juice backs up into the esophagus, it is less irritating. This allows the esophagus to heal.

Proton pump inhibitors are usually used:

• For severe or long-lasting GERD symptoms (heartburn), especially when the symptoms do not respond to H2 blockers.
• If the doctor finds you have severe inflammation of the esophagus (esophagitis).
• To prevent symptoms from coming back after the esophagus is healed (maintenance therapy) and to prevent complications of gastroesophageal reflux disease (GERD).

People with Barrett's esophagus are often treated with proton pump inhibitors because these drugs are more effective in lowering the acid level of stomach juices.

A nonprescription version of omeprazole (Prilosec OTC) is available for treatment of frequent heartburn. However, omeprazole for treatment of more serious ongoing conditions including GERD and peptic ulcers can only be prescribed by a doctor.

Proton pump inhibitors can suppress over 90% of stomach acid production. When the dose is adjusted correctly, proton pump inhibitors are very effective in eliminating symptoms of GERD.¹

These drugs are more effective than H2 blockers at healing severe inflammation of the esophagus (esophagitis).^{1, 2}

These medications are generally well-tolerated by the people who take them. Headache and diarrhea are the most frequent side effects that may occur. These medications may interfere slightly with the actions of warfarin (such as Coumadin or Panwarfin) and phenytoin (such as Dilantin).

See Drug Reference for a full list of side effects. (Drug Reference is not available in all systems.)

Some doctors may have concerns about the risk of using proton pump inhibitors to reduce stomach acid production for a long time. However, omeprazole has been used by some people for up to 12 years with no sign that any significant problems are caused by the reduced production of stomach acid, and concern over these possible risks has become much less. Proton pump inhibitors are approved for long-term use in Canada, Europe, and the United States.

For a very small number of people who take proton pump inhibitors, the medications do not work well. For these people, other treatments for GERD can be tried.

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Citations

1. Kahrilas PJ, Pandolfino JE (2002). Gastroesophageal reflux disease and its complications, including Barrett's metaplasia. In MH Sleisenger et al., eds., Gastrointestinal and Liver Disease, 7th ed., vol. 1, pp. 599–622. Philadelphia: W.B. Saunders.

2. Moayyedi P, et al. (2005). Gastro-oesophageal reflux disease. Clinical Evidence (13): 502–517.