Proton pump inhibitors for gastroesophageal reflux disease (GERD)

Examples

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Brand Name	Generic Name
Nexium	esomeprazole

Brand Name	Generic Name
Prevacid	lansoprazole

Brand Name	Generic Name
Prilosec	omeprazole

Brand Name	Generic Name
Zegerid	omeprazole and sodium bicarbonate

Brand Name	Generic Name
Protonix	pantoprazole

Brand Name	Generic Name
Aciphex	rabeprazole

These medicines are taken by mouth (as a pill or liquid) once or twice a day. Some of these drugs are given intravenously (IV) in the hospital.

A nonprescription version of omeprazole (Prilosec OTC) is available for treatment of frequent heartburn. But if you have been using Prilosec OTC to treat your symptoms for longer than 2 weeks, talk to your doctor. If you have GERD, it could be causing damage to your esophagus. Your doctor can help you find the right treatment.

How It Works

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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.

Why It Is Used

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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.

How Well It Works

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Proton pump inhibitors can heal the esophagus in about 8 out of 10 people who take them. In the 2 people who don't have healing of the esophagus right away, an increased dose or even the same dose for a longer time will usually work.¹

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

Proton pump inhibitors work best when they are taken 30 minutes before breakfast. If taking one pill before breakfast does not completely relieve your symptoms, talk to your doctor about taking another pill before dinner.

Side Effects

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

Proton pump inhibitors may have more serious side effects, too:

• They may reduce the amount of calcium your body absorbs. This may be linked to an increased risk of broken bones.²
• They may make it more likely that you will get certain infections.

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

What To Think About

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Some doctors may have concerns about the risk of using proton pump inhibitors to reduce stomach acid production for a long time. But they have been used by some people for many 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 medicines do not work well. For these people, other treatments for GERD can be tried. Sometimes proton pump inhibitors do not work well because people do not know when to take them. Proton pump inhibitors work best when they are taken 30 minutes before breakfast. If taking one pill before breakfast does not completely relieve your symptoms, talk to your doctor about taking another pill before dinner.

Complete the new medication information form (PDF) (What is a PDF document?) to help you understand this medication.

References

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Citations

1. Richter JE (2006). Gastroesophageal reflux disease and its complications. In M Feldman et al., eds., Sleisenger and Fordtran's Gastrointestinal and Liver Disease, 8th ed., vol. 1, pp. 905–936. Philadelphia: Saunders Elsevier.

2. Yang YX, et al. (2006). Long-term proton pump inhibitor therapy and risk of hip fracture. JAMA, 296(24): 2947–2953.

Credits

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Author	Monica Rhodes
Editor	Kathleen M. Ariss, MS
Associate Editor	Pat Truman, MATC
Primary Medical Reviewer	Kathleen Romito, MD - Family Medicine
Specialist Medical Reviewer	Jerome B. Simon, MD, FRCPC, FACP - Gastroenterology
Last Updated	March 31, 2008