POPULAR ACID REFLUX MEDICATIONS &
LIVER DISEASE: WHAT YOU NEED TO KNOW
If you live with
heartburn or acid reflux, you are likely taking medication to manage it. Proton
pump inhibitor (PPIs) drugs are medications that reduce gastric acid
secretions, and include popular brand names such as Prilosec, Nexium and
Prevacid. Not only do PPIs kill and ingest microbes and suppress gastric acid
secretions, but according to new research from
University of California San Diego School of Medicine, they can also
change intestinal bacteria which can promote the progression of liver
disease.
According to the
National Institute of Health, gastroesophageal reflux disease
(GERD) affects about 20% of the U.S. population. Drugs that treat this are
among the most commonly prescribed medications in the world and can be
easily obtained over the counter at your local drug store.
Approximately 6-15%
percent of the general population take PPIs. Up to 32% with non-alcoholic fatty
liver disease and up to 72% of those with cirrhosis take the acid reducing
drugs to block stomach acid secretions and relieve symptoms of frequent
heartburn, acid reflux and GERD. So with the rising number of people with
chronic liver disease in Western countries and liver cirrhosis as
end-stage organ disease now the 12th leading cause of death worldwide,
could this be a side effect of PPI medication use?
Possibly.
The
UCSD study, published October 10 in Nature Communications, showed that PPI use increased the
number of intestinal Enterococcus bacteria in mice. The
translocating enterococci bacteria lead to liver inflammation and liver cell
death. Notably, it was the expansion of intestinal Enterococcus
faecalis (E. faecalis) which was enough to exacerbate alcohol-induced
liver disease in mice.
PPI use increases the
risk of developing…
alcoholic liver disease among alcohol
dependent patients. Reduction of gastric acid secretion therefore appears to
promote overgrowth of intestinal Enterococcus, which promotes liver disease,
based on data from the mice models and humans.
This is definitely an undesired and adverse effect of PPIs
so it’s important to understand this and to consult with your doctor to ensure
the necessity of these drugs. Occasional use of PPIs for acute or short-term
problems are typically should not problematic however there are safety issues
associated with long term therapy. The American
Gastroenterological Association Institute recommends
determining the least potent therapy that controls acute GERD and then continuing
this therapy for eight weeks. After eight weeks, then one should be given a
trial off the medication.
If symptoms recur in fewer than three months,
there may be a need for maintenance therapy. Maintenance therapy can be
intermittent or continuous. Your doctor may also recommend you have an upper
endoscopy if there is doubt about the diagnosis or any other symptoms you may
be having are suggestive of another diagnosis.
So do PPIs have an important place in managing
acid reflux symptoms? Yes. Are they safe? Yes, when used appropriately. So
don’t continue to blindly take these medications over the counter indefinitely.
Talk to your doctor about your use and make sure to also include the following
preventative methods in your daily routine.
1.
Eat sparingly. When the stomach is full there is more reflux
into esophagus.
2.
Stop smoking. Nicotine relaxes the lower esophageal sphincter, making it
easier for food and acid to reflux into the esophagus.
3.
Avoid certain foods. Spicy foods, garlic, and alcohol can
increase acid production.
4.
Don’t drink carbonated beverages. These promote
burping, sending acid into the esophagus.
5.
Sit up after eating. Don’t lay down right away.
Gravity keeps food and acid in the stomach.
6.
Lose weight if appropriate. Extra weight causes muscular
structure to change, loosening the closure at esophageal sphincter.
7.
Ask your doctor to review your medications. Some can irritate
your esophagus.
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