ArcaMax

DEAR DR. ROACH: I am a 71-year-old male in good health. I read your recent column on the use of proton-pump inhibitors (PPIs). About eight years ago, I was hospitalized for 10 days due to a severe case of pancreatitis. The pain was beyond horrible. A scan indicated that I had a severe infection. It was finally determined that it was caused by acid reflux.

I've had acid reflux problems all of my life. I had to have Rolaids in my pocket until my primary care doctor prescribed famotidine. All helped, but at least once a day, I had to take something to keep the reflux down. When the doctors at the hospital prescribed pantoprazole, it was a great success. I could now eat anything anytime with no issues or side effects. After about three months, my primary doctor reduced it to 20 mg a day.

My symptoms are still good, and I'm still on it after all these years. I get blood work done every six months, and all is well. My kidneys are strong, and all my numbers are really good. The only thing my current doctor added was daily vitamin B12.

Am I following a prudent course here? According to what I've read on the matter, opinions differ slightly; however I did read that with what I'm doing, I should be fine. -- R.L.

ANSWER: PPIs are powerful medicines that prevent the acid-secreting cells in your stomach from making stomach acid. Even if a person has reflux (a backup of stomach contents in the esophagus) without acid, the esophagus isn't nearly damaged as much, so there are fewer symptoms. Most people with gastroesophageal reflux disease (GERD) get great relief with PPIs.

I have never heard of acid reflux that caused pancreatitis. As a medical student, I memorized all the causes of pancreatitis, from the most common causes (gallstones and alcohol) to the most obscure (thiazide drugs and scorpion venom), but I read nothing about GERD. I did read that continuous use of antacids (like Rolaids) can very rarely lead to pancreatitis; perhaps this was the case with you.

I see patients very frequently who have been on PPIs for years, sometimes without knowing even why they are taking them. Reflux symptoms are common, and doctors sometimes prescribe PPIs without a plan to stop them. So, they often get renewed year after year.

Although they are relatively safe drugs, they are clearly associated with a risk of intestinal infections, and they can reduce the absorption of calcium and B12 (hence your doctor adding in B12). A few people on long-term PPIs get a kidney complication called acute interstitial nephritis, and some people may get an increased risk of chronic kidney disease as well. A few studies have suggested a dementia risk, but other studies have not.

It is my usual policy in patients who have been on PPIs without a clear reason to taper them off and instead use non-pharmacologic methods (avoiding offending foods, not eating right before bed, and raising the head of the bed). Prescribing medicines like famotidine on an as-needed basis also works for GERD symptoms.

I find most people do just fine without PPIs. However, there are some people whose symptoms cannot be managed without medication. Together with the patient, doctors can decide whether the small risk of side effects is worth the benefit in symptom control.

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Dr. Roach regrets that he is unable to answer individual letters, but will incorporate them in the column whenever possible. Readers may email questions to ToYourGoodHealth@med.cornell.edu or send mail to 628 Virginia Dr., Orlando, FL 32803.

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