Proton Pump Inhibitors (PPIs) are the therapy of choice for symptom relief and healing of erosive esophagitis. There are no major differences in efficacy between the different PPIs. Included in this class are omeprazole-Prilosec�, esomeprazole-Nexium�, pantoprazole-Protonix� and lansoprazole-Prevacid� among others. An 8-week course of PPIs is the therapy of choice for symptom relief and healing of erosive esophagitis.While short term use of PPI’s can be helpful, high dose or long-term use of PPIs carries a number of possible increased risks and adverse effects. One such adverse effect that may lead to increased usage of PPIs further complicating patient health is rebound excessive acid secretion which has been recognized for many years by basic researchers but largely ignored by physicians, nurse practitioners, physician assistants and pharmacists. Sustained daily PPI therapy leads to increased acid production in the stomach that appears promptly when the drug is stopped and may show up in as little as 8 weeks with symptoms of severe, continuous heartburn. Depending on the dose and duration of exposure, it can take 2–3 months for the excessive acid secretion to return to normal levels. Symptoms can be managed with antacids and/or H2 antagonists such as ranitidine-Zantac�, famotidine-Pepcid� and nizatidine-Axid� which are known not to cause the excessive acid secretion.
Other undesirable effects from long-term use of PPIs may occur from decreasing vitamin B12 absorption. Signs and symptoms include anemia, numbness and tingling, headache, mood changes, confusion, irritability and weakness. In addition long-term use may lead to weakening bone strength and increased risk for fractures. Both the American College of Gastroenterology and American Academy of Family Physicians agree that the best approach for heartburn and mild reflux is life style modifications including diet changes and OTC H2 antagonists such as Zantac�, Pepcid AC� and Axid AR� when necessary. It is important to consult your pharmacist when taking an OTC medication to make sure there are no interactions with any other medications that you are taking.
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