When the contents of the stomach and duodenum flow back into the esophagus, it can cause symptoms such as heartburn, chest discomfort and acid reflux, a condition called gastroesophageal reflux disease. In addition to the symptoms that directly affect the esophagus, the disease can also cause problems in the area around the esophagus, including pharyngitis, hoarseness, pneumonia, persistent coughing, and asthma.
There are three main types of gastroesophageal reflux disease: reflux esophagitis, in which the lining of the esophagus is invaded by inflammation, nonerosive reflux disease, in which endoscopy may not show signs of inflammation in the esophagus, and Barrett's esophagus, a more serious condition in which long-term reflux can cause changes in esophageal cells. It is important to note that a large number of patients may be diagnosed with nonerosive reflux disease even if they do not exhibit significant esophageal inflammation endoscopically.
How to take proton pump inhibitors (PPIs)?
Proton pump inhibitors (PPIs) are the drugs of choice for the treatment of acid reflux disease because they are effective and long-lasting in reducing gastric acid secretion. Among them, omeprazole, esomeprazole (also known as esomeprazole), rabeprazole, lansoprazole and pantoprazole are commonly used PPI drugs.
If the initial treatment does not have the desired effect, the dose may be increased to a factor of two, or a different PPI may be tried. Increasing doses should be given in two doses, morning and evening, half an hour before meals. In addition, the drug should be swallowed whole, avoiding breaking or chewing to ensure the therapeutic effect. The minimum treatment cycle for PPIs is 8 weeks.
Given that acid reflux is a chronic condition that tends to recur, long-term treatment may help reduce the recurrence of the condition. Patients with mild disease may be treated as needed or intermittently to effectively control symptoms. Long-term PPI maintenance therapy is recommended for patients with persistent disease, particularly those with severe esophagitis or Barrett's esophagus.
For acid reflux that is difficult to control, i.e., does not improve after 8 to 12 weeks of double-dose PPI therapy, optimization of treatment should be considered first. This includes confirming that the patient is following medication guidelines and trying the most effective PPI, such as esomeprazole, and ruling out other possible health problems. The effect of PPIs may also be influenced by the genotype of the patient's hepatic metabolizing enzymes, and individuals with fast metabolizing types may have reduced efficacy due to the rapid breakdown of the drug.
Although long-term use of PPIs is effective, it may be accompanied by a variety of side effects, so it is not recommended to continue using PPIs for more than a year. Long-term use of PPIs may lead to an increase in the pH of the stomach, cause an imbalance in the intestinal flora, increase the risk of Clostridium difficile infection, and may interfere with the absorption of nutrients such as vitamin C, iron, magnesium and calcium, and may even increase the incidence of pneumonia. For patients requiring long-term PPI therapy, surgery or digestive endoscopy may be considered as an alternative.
Attention should be paid to the use of lazole drugs
The acids produced by the stomach are not only a key factor in the digestive process, but also play a vital role in the absorption of micronutrients. For example, this acidic environment is essential for the release and absorption of vitamin B12. Long-term use of proton pump inhibitors (PPIs) may reduce the efficiency of this process, especially in individuals with more than two years of continuous use, potentially leading to vitamin B12 deficiency. Therefore, it is recommended to increase vitamin B12 intake for individuals who have been using PPIs for a long time.
In addition, the presence of stomach acid is also critical for the absorption of iron, which helps convert iron from food into a more easily absorbed form. Individuals who take PPIs for a long time may affect this process, increasing the risk of iron deficiency anemia.
PPI use has also been linked to an increased risk of hypomagnesemia, a condition that can lead to a range of problems such as fatigue, convulsions, and cognitive impairment. At the same time, long-term use of PPIs may also increase the risk of osteoporosis and fractures, mainly because they affect calcium absorption and bone health.
With regard to gut health, long-term use of PPIs may make the stomach environment more alkaline, reduce the barrier function of gastric acid, and thus increase the risk of intestinal infections. In addition, studies have shown that long-term use of PPIs may be associated with an increased risk of certain types of cancer, including stomach cancer and colorectal cancer.
The effects on lung and kidney health are also not negligible, and long-term use of PPIs may increase the risk of pneumonia and interstitial nephritis. Cognitive function may also be affected, and studies have shown that long-term PPI use is associated with an increased risk of Alzheimer's disease.
Especially for pregnant and lactating women, PPIs should be used with more caution. Finally, although PPIs such as omeprazole provide a potent acid suppression effect, they should be carefully selected and used according to individual health conditions under the guidance of a physician, given their potential risks.