Proton pump inhibitors (PPIs) are a class of medications used to treat conditions involving excess stomach acid, such as gastroesophageal reflux disorder (GERD) and stomach ulcers. They work by binding to an enzyme or protein in the stomach lining and preventing the release of acid into the stomach. This acid production leads to symptoms such as: painful burning sensation in the chest and pain or difficulty swallowing.

Understanding Proton Pump Inhibitors

PPIs reduce acid levels in the stomach. Many PPI products are available. Some are available over the counter, while others require a prescription from a healthcare professional. PPIs are some of the most commonly prescribed drugs worldwide. In 2019, Prilosec (omeprazole) was the eighth most frequently prescribed drug in the United States, with more than 52 million prescriptions.

How Do Proton Pump Inhibitors Work?

PPIs bind to a specific type of protein, called an enzyme, located inside the parietal cells lining your stomach. This enzyme is the hydrogen-potassium ATPase pump (H+/K+ ATPase), or more simply the proton pump.

It normally functions to release H+ ions, creating hydrochloric acid that is released into your stomach, increasing the acidity level and maintaining a low pH environment. When this pump becomes clogged, acid production decreases. This less harsh environment, ulcer healingIt relieves heartburn and acid reflux symptoms and reduces damage to the esophagus.

Uses of Proton Pump Inhibitor

Common uses of proton pump inhibitors include:

• GERD is a condition in which stomach acid flows back into the esophagus, which can irritate and damage the esophagus and cause heartburn, chest pain, or difficulty swallowing.
• Barrett’s esophagus It is a condition that can result from chronic GERD and esophageal damage, in which the normal esophageal lining is replaced by a different type of cell that is more acid-resistant, but can also increase the risk of esophageal cancer.
• Stomach ulcers, also known as gastric ulcers, are sores in the stomach lining caused by an overly acidic environment. Helicobacter pylori (H. pylori) infectionor excessive use of similar drugs nonsteroidal anti-inflammatory drugs (NSAIDs) such as Advil or Motrin (ibuprofen) and Aleve (naproxen).

Examples of Proton Pump Inhibitors

There are several drugs in this class. Examples of prescription-only PPIs include:

• Aciphex (rabeprazole)
• Dexilant (dexlansoprazole)
• protonix (pantoprazole)

Some PPIs can be purchased without a prescription without a prescription, including:

• Nexium (esomeprazole)
• Prevasit (lansoprazole)
• Prilosec (omeprazole)
• Zegerid OTC (omeprazole + sodium bicarbonate)

Safety Precautions

Interactions

There are some important interactions between PPIs and other medications:

• Drugs metabolized by cytochrome P450 enzymessuch as Plavix (clopidogrel), warfarin, phenytoin, and some antidepressants Elavil The effects of (amitriptyline) and Lexapro (escitalopram) may be increased or decreased when taken with PPIs that block the CYP2C19 enzyme.
• Drugs that require an acidic environment in the stomach for absorption Their effects may be reduced when taken with PPIs that increase pH (or decrease acidity). Examples include: iron supplementsVitamin B12 and antifungal Medicines such as ketoconazole and itraconazole.
• digoxin Levels may increase when taken with PPIs, potentially increasing the risk of digoxin toxicity.
• Diuretics Lasix (furosemide) and hydrochlorothiazideIt may increase the risk of low magnesium levels (hypomagnesemia) when combined with PPIs.

Who Should Be Careful When Taking Proton Pump Inhibitors?

PPIs are not suitable for everyone and some groups of people, including; These people need to be careful taking them, especially for longer than four to eight weeks:

• People osteoporosis People with a high risk of bone fractures (decrease in bone mass or decrease in bone mineral density) should be careful about long-term use of PPIs. The stomach contains hydrochloric acid, which is necessary for the proper absorption of calcium. PPIs lower the levels of this acid, resulting in decreased absorption and eventually decreases. bone mineral densityIt may increase the risk of fractures of hip, wrist and spine bones.
• People at high risk of infectionfor example immunocompromised or older adults should use caution when taking PPIs. PPIs reduce the acidity in the stomach, which can allow some harmful bacteria to thrive and grow, otherwise kept in check by the low pH in the stomach. This can lead to a greater risk of infection.
• Pregnant and breastfeeding people One should use PPIs only under the supervision of a healthcare professional as there is limited data on the safety of their use during pregnancy.
• People with kidney disease Caution should be exercised with long-term PPI use as it has been linked to an increased risk of chronic kidney disease and acute interstitial nephritis.
• People Vitamin B12 deficiency They may be at increased risk from PPIs because they can interfere with the absorption of vitamin B12.

Summary

Proton pump inhibitors (PPIs) are medications that reduce stomach acid production. They are used for conditions caused by the highly acidic environment in the stomach, such as gastroesophageal reflux disease (GERD) and peptic ulcers.

PPIs reduce acid production by inhibiting a protein in the stomach lining called the proton pump. The protein is responsible for the release of H+ ions into the stomach. Common examples of PPIs include Prilosec (omeprazole), Protonix (pantoprazole), and Nexium (esomeprazole). In general, PPIs are safe for short-term use, but long-term use may increase the risk of vitamin and nutrient deficiencies, bone fractures, and gastrointestinal infections.

Be sure to discuss the use of PPIs with your healthcare provider, as they should be used with caution in some groups.