In recent years, quite a few patients have come to me with reflux symptoms who are being treated with PPI medications (Nexium, Omeprazole, etc.) and are interested in reducing them.

I always ask them to get permission from their gastroenterologist to see that stopping the medication cannot cause them harm, but to better understand the issue, I asked Dr. Roy Dekel, a senior gastroenterologist at Ichilov and Maccabi, questions about stopping the medication and in general about the use of PPI medications.

If someone is diagnosed with gastritis, does they have to take a PPI for life?

Dr. Dekel: "We need to differentiate between gastritis and reflux. In gastritis caused by Helicobacter pylori, Helicobacter pylori must be treated. In gastritis caused by NSAIDS (Advil, Arcoxia, etc.), the medications must be stopped."

If someone has been diagnosed with reflux - in most cases there is no need to take regular treatment for life. We try to keep patients on the lowest dose that allows them a good quality of life. Most patients can manage with medication taken as needed.

In severe cases/trouble with the esophagus/Barrett's - permanent treatment is necessary."

*My addition (Dana): Barrett's is a process in which the esophageal epithelium has changed. It is a condition diagnosed during gastroscopy.

Is it permissible for a person to discontinue PPI treatment on their own initiative and in what cases?

"There is no danger in lowering PPIs. Only in the case of Barrett's is there an indication for regular use. If a person stops taking medication and suffers from heartburn, Barrett's will not occur. Other complications can occur, but they will not happen quickly."

Discontinuing treatment may impair quality of life but will not endanger it.

On the other hand, PPI medications are very safe medications, so it is not necessary to stop them if quality of life is compromised as a result of discontinuation.

"You can take them as needed, meaning you can take them for a week or two or for a few days when needed."

Is there a difference between different PPI drugs? Is there an advantage to Nexium or Dexilant as a drug that can be taken as needed compared to Omperdex, Lanton, and Lusak, which must be taken only in the morning?

Dr. Dekel: "PPI medications are supposed to be taken half an hour - an hour before meals. Nexium and Dexilant can be taken regardless of food - that's where they differ."

"Dexilant has a unique release mechanism compared to other PPI drugs. The drug is released in two stages: at the beginning of the small intestine and at the end of the small intestine, and therefore, according to the drug's creators, the drug works over a long period of time and also covers the night. In reality, the delta is not that significant, the drug is more expensive and does not always justify itself."

Are there any side effects to long-term use of PPIs?

"The bottom line is, as of today, the drugs are safe to use. Studies have not shown that they pose any risks."

The instructions are to continue treatment if you need it and if you don't need it, don't take it.

"If you need to take it, there is no reason not to take it because of concerns about dementia/osteoporosis or other things because, as mentioned, they have not been proven in studies, but if the medication is not needed, you can stop taking it."

A question that is not related to medications but to the diagnosis of reflux: Are there symptoms of reflux that are not automatically linked to reflux and therefore missed in the diagnosis?

"The classic symptoms of reflux are: heartburn and regurgitation of acidic contents. In addition, there are symptoms that can be associated with reflux and they are cough, worsening of asthma, symptoms in the pharynx and throat such as sore throat or hoarseness."

That's it for today, I hope Dr. Dekel's answers helped you 😊.

Regarding side effects of using PPIs, I have encountered patients for whom the drugs caused diarrhea and other digestive problems. Regarding osteoporosis, I understand that this is currently unproven.

I think it's worth trying to give up the medications if possible (and replace them with acupuncture/dietary changes or anything else that helps), but if you have to take them, then it's good to know that you can take them as needed and not for life as was once recommended.