Tuesday, August 28, 2018

Heart Burn: Are we treating for too long?

Heart burn is a common phenomenon that can be characterized by a burning sensation in the throat, and chest. Heartburn is relatively easy to treat with a variety of OTC and prescription products. Proton Pump inhibitors (PPIs) are the premier drug class for treating heart burn, and have had a reputation for being benign drugs, until recently.

New evidence is emerging about long term use of PPIs showing correlations between opportunistic infections, pneumonia, and malabsorption of nutrients.1,2 The current recommendation for PPIs for heartburn is 8 weeks, but the reality is many patients surpass this time-frame.

Health care providers should be striving to limit PPI therapy duration in patients to avoid these complications until more information is available.

Difficulty Ceasing?

In patients that have surpassed the recommended 8-week therapy duration, there are two main barriers that make it difficult to terminate therapy.

One of the barriers stopping PPIs therapy cessation is patient preference. Most patients are not optimistic about stopping their PPI therapy, because of how well they work.

The second barrier that causes issues with cessation of PPI therapies is the perceptions of health care providers.  PPIs have been available since 1988, and many healthcare professionals view them as safe drugs. Since most health care professionals view them as harmless, they are less likely to intervene with patients using PPIs long term.

Who does this affect the most?

Although long durations of PPI therapy should be a concern for all patients, it is especially troublesome in older adults. Older adults are more prone to infection, and are more likely to suffer from nutritional deficiencies. Long term PPI use in older adults also adds an extra layer of issues due to drug interactions. To limit this potential harm, it is important to always address any PPI use in older adults.

What can we do?

The best way to decrease complications of long term PPI use in heartburn patients is to play a more active role in product selection, and therapy duration discussions.


1) Recommend lifestyle interventions such as exercise, weight loss, and limiting meals before bed.3

2) Consider other drug classes first before PPIs when dealing with mild & moderate cases of heartburn.

3) Discuss with patient and prescribers expected duration of therapy prior to PPI initiation.

4) Investigate any patient prescribed PPIs for longer than 8 weeks and discuss possible taper options.

5) Attempt to taper patients on long term PPIs at least once a year using a combination of life style modifications and other drugs to help.

Quick Tip: Never stop a PPI abruptly due to risk of rebound hyperacidity.

Although PPIs are used mostly to treat minor ailments, it is important to remember the associated risk with long term use. 

Hopefully these tips will be helpful for everyone, because I am signing off.
I hope you have enjoyed my posts & are excited for the next student blogger.


Derick Oduro


1) Trifan, Anca, et al. “Proton Pump Inhibitors Therapy and Risk of Clostridium Difficile Infection: Systematic Review and Meta-Analysis.” Advances in Pediatrics., U.S. National Library of Medicine, 21 Sept. 2017, www.ncbi.nlm.nih.gov/pmc/articles/PMC5643276/. 

2) Heidelbaugh, Joel J. “Proton Pump Inhibitors and Risk of Vitamin and Mineral Deficiency: Evidence and Clinical Implications.” Advances in Pediatrics., U.S. National Library of Medicine, June 2013, www.ncbi.nlm.nih.gov/pmc/articles/PMC4110863/. 

3) Ness-Jensen E, Lindam A, Lagergren J et al. Weight loss and reduction in gastroesophageal reflux. A prospective population-based cohort study: the HUNT study. Am J Gastroenterol 2013;108(3):376-82.