People who take proton pump inhibitors

Dyspepsia

The main symptom of dyspepsia (or indigestion) is pain or discomfort in the upper abdomen.

Heartburn

Another symptom of dyspepsia is heartburn (also known as acid reflux). This is a burning feeling that rises from the upper abdomen or lower chest towards the neck.

Proton Pump Inhibitors (PPIs)

These medications reduce the amount of acid that your stomach makes. The most commonly prescribed PPIs are called Omeprazole and Lansoprazole. By lowering the acid level they can help to relieve the symptoms of dyspepsia and heartburn.

How long should you take a PPI for?

How long you need to take a PPI for will depend on why you are taking it as they can be used for a number of different conditions. Some patients will need to take these medications long-term.  People with certain conditions, such as severe oesophagitis (inflammation of the gullet), strictures (narrowings) or Barrett’s oesophagus usually need long-term treatment with a PPI. People taking medications that can cause peptic ulcers (like ibuprofen) may also need long-term treatment with a PPI. If you have been told you have one of these conditions then it is better that you stay on your PPI treatment long-term.

If you are using your PPI to ease symptoms of heartburn and indigestion regularly then there is a possibility long-term use might cause you some problems. Lowering the amount of acid produced by your stomach probably makes it more difficult for your body to absorb calcium, which in the long term could increase your chance of getting thinning of your bones (osteoporosis) which could cause your bones to break more easily. It can also affect how well your body absorbs vitamin B12 from food leading to B12 deficiency and anaemia. Stomach acid is thought to protect you against certain infections like Clostridium difficile and pneumonia, so these may be more likely in people who take regular PPIs.

Short term Treatment

To start with, you may be given a prescription for four weeks. If your symptoms continue then you may be prescribed another four weeks of treatment. Many people find that after this time their symptoms are better. However, it is common for symptoms to come back again, sometimes after a number of months.

Long-term Treatment

After you have finished a course of PPI treatment, you may have your treatment ‘stepped down’ to one of the following options:

1. Stop PPI – You might decide to use an antacid or ‘alginate’ available from pharmacies when you experience symptoms. If this fails to help, your doctor may prescribe another short course of a PPI.
2. Take PPI only when needed – You might decide to take your PPI only when you have symptoms. When the symptoms are relieved (often after a few days) you stop taking the PPI.
3. Reduced dose – You might decide to ask us to prescribe s lower dose or prescribe a different medicine to keep your symptoms away.

Stopping your PPI

Some people find that when they stop taking their PPI their symptoms are worse than before. This can be a particular problem if you have been taking it for a long time. This is because if you take a PPI for more than a few weeks, your stomach will increase its ability to make acid. This means that for a while after you stop taking your PPI the acid levels in your stomach may be higher than before you started your treatment.

If you have symptoms when you stop your PPI, ask your doctor or pharmacist for a type of medication called an antacid or ‘alginate’ which can help you until your acid levels return to normal.

If you have been taking a PPI for more than 8 weeks at a high dose, your doctor may advise that you take a lower dose for a few weeks before stopping completely and to take an ‘alginate’ if any of your symptoms return.

What should you do if you develop problems?

You should see your doctor if your symptoms do not get any better, get worse or if you develop any of the following:

• Vomiting, especially if this contains blood or material that looks like coffee grounds
• Dark, sticky bowel movements
• Difficult or painful swallowing
• Unexplained weight loss
• Chest pain, chest pain that gets worse with or after exercise or chest pain that goes into your chin or left shoulder. These may be signs of a heart problem.

Can you do anything to improve your symptoms without taking a PPI?

• Try to keep to a healthy weight
• Avoid food and drink that make your symptoms worse (for example, spicy or fatty foods, chocolate, coffee, cola drinks and orange juice)
• Eat meals at regular times
• Avoid large or late meals and avoid bending over or lying flat immediately after eating
• Avoid tight belts or clothing
• Avoid buying medications that can make your symptoms worse, such as some pain killers (ask your doctor or pharmacist which medications are safe to take)
• If your symptoms are worse at night and disrupt your sleep, try raising the head of your bed by 10–15 cm (4–6 inches) using blocks under the legs of your bed or use a wedge shaped pillow to raise your head
• If you drink more than two standard drinks of alcohol a day, reduce the amount you drink
• If you smoke, consider stopping as this is likely to improve things. You can access support with stopping smoking by calling Be Well Tameside on 0161 716 2000 or emailing bewelltameside@nhs.net.