Proton Pump Inhibitors (PPI)

Question 1

PPI: Prescribed for

Answer 1

Gastro-oesophageal reflux disease (GORD), prevention of NSAID-associated ulcers, triple therapy with antibiotics for gastric / duodenal ulceration

Question 2

PPI: Examples

Answer 2

Omeprazole, lansoprazole, esomeprazole

Question 3

PPI: Mode of action

Answer 3

Blocks gastric cells proton (hydrogen) pump

Question 4

PPI: Cautions

Answer 4

Liver disease, pregnancy, breast-feeding, gastric cancer (masks symptoms)

Question 5

PPI: Side effects

Answer 5

Headache, GI disturbances, rebound gastric hypersecretion and heartburn after discontinuation of drug

Question 6

PPI: Long-term side effects

Answer 6

• Increased risk of GI infections (e.g.,

Clostridium difficile) and SIBO. Alkaline gastric pH allows bacterial survival.

• Increased fracture risk: Reduced calcium absorption leads to decreased bone mineral density, possible inhibition of osteoclast activity.
• Vitamin B12 deficiency: Gastric acid is needed for release of vit. B12 from proteins to help intestinal absorption.
• Low blood magnesium due to decreased intestinal absorption.

Also reduced iron absorption (= possible iron deficiency anaemia)

Question 7

PPI: Withdrawal

Answer 7

PPI withdrawal depends upon several factors including the dose and duration of treatment. Sudden withdrawal may cause rebound reflux. The 5R approach supports clients to reduce and withdraw from PPIs over a period:

• Remove:
  ‒ Remove trigger foods (acidic — tomatoes, alcohol, caffeine, spicy food, fatty foods, dairy, chocolate). Identify and manage any food intolerances e.g., gluten. Stop smoking.
  ‒ Avoid overeating, avoid fluid intake with meals — also to reduce stomach distension. Eat last meal at least 4 hours before bed
  – Prone position ― elevate head of bed by 4‒6 inches.
  – Reduce intra-abdominal pressure weight loss / avoid tight-fitting clothes
• Replace (introduce):
  ‒ Increase nutritious foods to replace deficiencies e.g., magnesium rich. Clients may also need supplementation B12, magnesium, Vitamin A (introduce a general multivitamin and mineral).
  ‒ Digestive enzymes / betaine HCl / digestive bitters
• Repopulate: which can reduce the absorption
  ‒ Introduce probiotics — some of oral drugs and decrease their clients may suffer from SIBO effectiveness. Therefore, you after long-term acid suppression. should take slippery elm at least one hour after taking an oral drug.
• Repair:
  – To protect and repair the gut lining ― use slippery elm, marshmallow, chamomile, glutamine.
• Rebalance:
  – Reduce and manage stress — acupuncture, aerobic exercise (not following meals). Stress is a key trigger