I have a confession to make.
asserted
I → have → confession
Something has gone horribly wrong with the way we GPs hand out heartburn medication.
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GPs → go → medication
Known as proton pump inhibitors, or PPIs, these tablets are some of the most popular medicines in the world.
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tablets → know → world
This is hardly surprising given that the condition, also known as acid reflux, affects more than six million Britons.
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condition → give → Britons
The uncomfortable problem, where stomach acid rises into the throat leading to nausea, discomfort and chest pain, can make life a misery for patients, not least because it can disrupt sleep.
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it → rise → sleep
The tablets – which include omeprazole, lansoprazole and esomeprazole – are highly effective and can banish symptoms within hours.
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which → include → hours
They are also given to patients on long-term courses of anti-inflammatory tablets to protect them from dangerous stomach bleeds.
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They → give → bleeds
However, I now tell my patients to stop taking them as soon as possible.
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I → tell → them
This is because they were never designed to be taken long-term, yet studies show that 40 per cent of patients take them for at least a year and a tenth take them for an astonishing five years or more.
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tenth → design → years
Around one in five Britons suffers from acid reflux, which occurs when stomach acid leaks into the oesophagus and throat, causing a burning sensation and chest pain
And I find this very worrying because research shows that overusing these tablets raises the risk of bone breaks, vitamin deficiencies and potentially even dementia.
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overusing → suffer → breaks
When I tell my patients this, they often say that they fear stopping the tablets will mean their heartburn returns with a vengeance – and it's certainly true that quitting them suddenly can cause problems.
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quitting → tell → problems
But in fact, there are a series of lifestyle changes that patients can make to kick PPIs.
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patients → be → PPIs
And patients taking them alongside anti-inflammatories can also, with the right steps, come off them too.
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patients → take → them
First, I should explain what causes heartburn.
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what → explain → heartburn
It happens when the ring of muscle at the bottom of the food pipe, also known as the oesophagus, doesn't close properly, allowing acid from the stomach to flow back upwards into the gullet.
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acid → happen → gullet
This is what causes that burning sensation behind the breastbone, along with a sour taste in the mouth, and it's why symptoms are often worse after eating, lying down or bending over.
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symptoms → cause → mouth
Around ten million people regularly take omeprazole – or similar drugs such as lansoprazole – costing the NHS about £300million a year
Over time, heartburn can also inflame the lining of the oesophagus, which can raise the risk of oesophageal cancer.
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which → cost → cancer
PPIs work by switching off the tiny pumps in the stomach lining that produce acid, cutting down how much is made in the first place.
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much → work → place
This eases symptoms and gives the lining of the oesophagus a chance to heal.
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This → ease → chance
Used in short bursts, these drugs can be miraculous – ending the suffering of heartburn patients.
However, over the years, researchers have realised that we do, in fact, need stomach acid and limiting its production for too long can have serious consequences.
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limiting → use → consequences
We now know that patients taking PPIs are more likely to suffer nutrient deficiencies including vitamin B12, magnesium and iron, all of which can lead to fatigue and weakness.
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all → know → fatigue
They are at a greater risk of developing chronic kidney disease, an irreversible and potentially deadly disease.
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They → develop → disease
PPIs users are also more likely to suffer bone fractures, certain infections and, on rare occasions, gastric cancer.
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users → suffer → occasions
There is even some evidence that PPIs patients have an increased chance of developing dementia – though more research is needed to prove this link.
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research → be → link
However, all told, for many patients the reasons for coming off PPIs far outweigh those for staying on them – not least because there are a series of lifestyle changes that can make them obsolete.
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them → tell → changes
GP, author and broadcaster Dr Philippa Kaye
Losing weight, if you carry excess weight, has the strongest evidence base of any lifestyle intervention.
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you → lose → intervention
Extra weight increases pressure in the abdomen and worsens reflux, and even a modest loss of five to ten per cent of your body weight can significantly improve symptoms.
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loss → increase → symptoms
It's also worth paying attention to triggers.
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It → pay → triggers
Large meals, eating close to bedtime, alcohol, caffeine, chocolate, fatty or spicy food and fizzy drinks can all provoke reflux, so cutting back on these can make a real difference.
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cutting → eat → difference
Stopping smoking and cutting back on alcohol more generally will help too, as will something as simple as raising the head of the bed.
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something → stop → bed
If symptoms tend to be worse at night, tilting the bed so your head and chest are higher can stop acid travelling back up while you sleep.
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you → tend → bed
It is important that patients do not come off the tablets suddenly, as this can make symptoms worse.
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symptoms → come → tablets
Instead, patients should come off them gradually with the help of their GP.
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patients → come → GP
But for heartburn patients, these changes could be enough to get them off PPIs.
uncertain
changes → get → PPIs
However, not all PPIs patients are taking them for heartburn.
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patients → take → heartburn
There are those on anti-inflammatory painkillers, such as ibuprofen or naproxen, for chronic pain conditions, who also need them.
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who → be → them
These drugs can irritate the stomach lining and trigger dangerous bleeds – and PPIs can stop this from happening.
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PPIs → irritate → this
In fact, some studies suggest that the majority of patients who take PPIs for a year or more are taking them alongside anti-inflammatories.
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who → suggest → inflammatories
So what can these patients do to kick their PPIs?
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patients → do → PPIs
The first step patients can take is to talk to their GP to find out whether their dose of anti-inflammatories can be lowered or whether it can be taken only as needed rather than every single day.
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it → take → day
…and 9 more, not listed.
The Aporia
