Emerging evidence from a number of studies suggests there is an association between long-term use of proton pump inhibitors and the development of gastric cancer. If needed, alternatives to PPIs are available.
PPIs and Cancer
When digesting food, the stomach uses gastric acid to break food down. During this process, cells in the stomach called G cells produce a hormone called gastrin, which signals to other cells to pump acid. PPIs stop acid from being produced.
The body responds by recognizing there isn’t enough acid and seeks to make more by producing more gastrin. Too much gastrin has been found to promote the growth of gastrointestinal tumors.
Some studies have suggested that gastric-acid suppression from PPIs leads to:
Elevated levels of gastrinInflammation of the stomach liningBacterial overgrowth
This in turn may play a role in the development of cancer in the gastrointestinal system.
A 2019 study found that even when helicobacter pylori infection was eradicated, the long-term use of PPIs was still associated with a twofold increased risk for gastric cancer.
Should I Stop Using Prilosec?
PPIs like lansoprazole (Prevacid) and omeprazole (Prilosec) are available over the counter without a prescription. But long term use can be problematic.
Reduced B12 levelsIncreased risk of pneumoniaIncreased risk of hip fracturesIncreased risk of dementiaIncreased risk of heart attackIncreased risk of chronic kidney disease
The U.S. Food and Drug Administration (FDA) says over-the-counter (OTC) PPIs should only be taken for the 14-day course up to three times a year.
In some cases, medications called an H2 blocker like Pepcid or Tagamet may be appropriate. After a week of taking an H2 blocker instead of PPIs, the PPIs will be out of the system. It is then possible to switch to OTC antacids on an as-needed basis.
However, some people may still experience difficult symptoms after coming off PPIs and may need to go back on them at a higher dosage.
Before making any changes to medications or dosages, patients who are on PPIs should discuss with their healthcare provider whether they should continue taking the medication, or whether other options might be appropriate.
Alternatives to PPIs
Although PPIs are the most common medication prescribed in the U.S., there are alternative options available. These can include lifestyle modifications, alternative therapies, and other medications.
Other Medications
There are other medications that can be used instead of PPIs in the treatment of conditions like acid reflux.
H2 blockers are medications that lower the production of hydrochloric acid in the stomach. They are absorbed quickly and the resulting acid suppression lasts for several hours after the medications have been taken. H2 blockers can also work to counter the effect of acid on the esophagus that causes heartburn.
H2 blockers include:
Cimetidine (Tagamet)Ranitidine (Zantac)Nizatidine (Axid)Famotidine (Pepcid)
Antacids may be appropriate in some cases. These drugs work by neutralizing stomach acid. They are the oldest treatment for heartburn on the market. Most antacids are a mixture of aluminum and magnesium hydroxide. Some may also contain sodium bicarbonate.
Lifestyle Changes
As well as medications, lifestyle changes can in some cases assist with conditions treated by PPIs like acid reflux or GERD.
Lifestyle changes that may help include:
Avoiding spicy, fatty, or acidic foodsLosing weightQuitting smokingEating smaller mealsGetting adequate sleepRaising the head of the bed at night for sleepAvoid food and drinks that might trigger reflux like citrus, chocolate, mints, coffee, alcohol, and tomato-based products
Alternative Therapy
Some alternative therapies that may be helpful as an alternative for PPIs include:
AcupunctureHypnotherapyHerbal remedies
Herbal remedies that may be helpful include:
Chamomile: Chamomile tea can soothe the digestive tract, but shouldn’t be taken by those who have a ragweed allergy. Licorice: This is believed to help the coating of the esophagus, to protect it from irritation due to stomach acid. Ginger: This has been used for centuries to aid in digestion and as a remedy for heartburn.
Prevention
There are a number of steps that can be taken that may help avoid acid reflux or GERD and could assist in avoiding the need for medications.
Some ways to prevent acid reflux or GERD in the first place include:
Maintaining a healthy weight: An increased weight can increase the risk of acid reflux and GERD. Losing weight if overweight can help avoid this, as can maintaining a healthy weight. Don’t smoke: Nicotine is the ingredient in tobacco that makes smoking addictive. It is believed nicotine also relaxed the esophageal sphincter which can lead to reflux or heartburn. Avoid certain foods and drinks: As mentioned above, avoiding spicy, fatty, or triggering foods and drinks like tomatoes, mint, or coffee can help avoid reflux. Avoid carbonated beverages: Bubbly drinks like soda and sparkling water can cause burping, which sends acid to the esophagus. Drinking flat drinks like water will help avoid this. Stay upright after eating: Sitting upright or standing after eating helps keep acid in the stomach. Eating three hours before going to bed will help avoid reflux. Avoid speedy activity after eating: Vigorous exercise or workouts that involve bending over can cause acid to rise to the esophagus. Wait a couple of hours after eating before working out vigorously. Sleep with your head elevated: When sleeping, your head should be six to eight inches higher than your feet. This can be achieved through a foam wedge to support the upper parts of the body or using bed risers on the legs of the bed near the head. Check medications: Some medicines can relax the sphincter, causing reflux. Others can irritate the esophagus. Always speak with your healthcare provider before discontinuing or changing any medications.
A Word From Verywell
If you are in doubt about whether proton pump inhibitors are the right medications for you, speak with your healthcare provider. It is important not to cease taking these medications suddenly if you have been on them for a while. If appropriate, your healthcare provider may suggest alternative options to PPIs. It is important GERD is controlled and monitored by a healthcare provider, as uncontrolled GERD can pose serious health risks.
