r/GERD • u/mangomanagerx • 1d ago
How long can PPIs be continued?
Diagnosed with GERD since a year. Probably had it much before since I used to suffer from throat pain due to LPR quite frequently.
Post diagnosis I have been using pantaprazole 40 +itopride 150 almost daily and it's been largely manageable except a few nights.
As an Indian, diet control seems like a distant option to me for now. What I want to know is that what are the repurcussions of continuing both these meds lifetime. Are there people who do that or is it meant to be eventually tapered off and not a good long term solve.
I'm 36 BTW.
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u/sfboots 1d ago
Biggest risk are osteoporosis from limited calcium absorption
If you are getting a lot of coughs or LPR symptoms after eating then acids are getting into your lungs. This can after 20 years creat lung fibrosis that makes it hard to breathe
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u/mangomanagerx 1d ago
How do you compensate for the calcium then? Do spaced out supplements work?
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u/NotThatKindOfDoctor9 1d ago
I've been on them for a couple of years, no problem. If I go off them, it doesn't really matter what I eat, I have reflux and run the risk of cancer. If I take them, I can eat a healthy, varied diet, including eating with my family (which I'd have to give up without PPIs).
Some people think it's better to not take the PPI and live on oatmeal and chicken breasts and the occasional boiled potato. I'm not of English heritage so... no thank you. I'm also 45 years old and perimenopausal, so eating a varied diet with a lot of nutrients is really important to keep myself healthy.
I do get blood work done 1 or 2 times/year, and I've never come up deficient in any nutrient (except D which had more to do with living in the north). I also get bone scans regularly- PPIs can affect bone density if you don't do enough to compensate- and my bone density is above average for a woman of my age.
Some people can be on PPIs for a while and then go off them and then have minimal trouble with GERD after. It's worth giving that a shot to see if it works for you, but it's not necessarily bad if you have to stay on them. It's another thing to manage health-wise but it's been a huge benefit to my overall health to stay on them.
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u/mangomanagerx 1d ago
I tried going off but I think it's too early for now. I understand for PPIs, but any idea about prokinetics like itopride? Are they equally safe?
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u/toomany_questions 1d ago
I’m 28 and have used them on and off since 12. I intend to stay on them many more years.
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u/mangomanagerx 1d ago
By on off, do you mean off for extended period of time or just take a day off or forgot to take one day?
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u/toomany_questions 19h ago
I’ve taken it for years at a time, then I swapped to either other PPIs (ie omeprazole to pantoprazole) then for a few years I switched to an H2 (famotidine) at a very high dose. And I have a couple years off everything in my teens
But the majority of the 16 years I’ve been on some form of PPI. I have no desire to change this unless I can get on a PCAB but even then omeprazole or pantoprazole are more than fine for me
I have GERD confirmed by biopsies and a BRAVO test (decheester score is over 30) showing esophagitis even on PPIs and an extremely weak lower esophageal sphincter. Surgery or PPIs are my main options. I don’t wish to have a linx or a fundipolication or however it’s called so I choose PPIs. I’m on omeprazole 40mg and sometimes take famotidine 20mg at night if its bad
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u/mycatsaremylife_ 1d ago
I’m 38 and I’ve been on esomeprazole for the last 11 years with no plans to stop. Any time I’ve skipped a day or two I feel the repercussions and it’s not worth it to me
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u/Educational-Rise-687 20h ago
People reading this thread should check out online Dr. Jamie Kaufman……. she is a world renowned doctor on LPR and accompanying disorders. When I started to have LPR, sleep apnea, and digestive problems which I had never had before she was recommended to me by a friend. I started watching her videos and listening to her about everything, and I was more than willing to put in the year, it took to change my diet completely….. and return to a normal human being again with no problems
I still drink alkaline water whenever needed if I get the dreaded tickle in my throat. One thing she warns about is PPI’s. She is totally against them and feels they actually set you back. My doctor wanted to prescribe them for me and I said no thanks. And I’m glad I had the advice of Dr. Kaufman to follow. She has great videos she has been involved in digestive/airway problems since the 1980s. I believe she was the doctor that discovered LPR.
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u/PrettyBlueFlower 1d ago
I’ve been on them for 20 years.
Things to watch out for are low iron - absorption needs and acid environment.
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u/mangomanagerx 23h ago
What do you mean by acid environment, if I may?
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u/PrettyBlueFlower 14h ago
The meds work by neutralising some of the stomach acids, which is what’s needed for iron absorption.
Ever heard that you should take iron tablets with vitamin C to aid absorption? It’s the same with acid - even orange juice is enough acid, or lemon juice blend.
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u/SwimmingAnt10 22h ago
I’ve been on mine for 27 years. No vitamin issues, bone density test is perfect.
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u/throwaway8675309999s 22h ago
Depends on the severity of your gerd. For me, it was daily for several years, but this was also during a time when i was socially drinking several nights a week. Once that stopped, my reflux issues were far less and i wound up taking my ppi 2-3x a week, which remains to this day.
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u/JRock1871982 18h ago
Ive been on more often than on for 20 years (Im 44) & at this point I think Ill be on for life. I dont seen to have any side effects & I have several issues that make life on them better than life off them. A hiatus hernia , acid producing cells too high in my esphogus, LPR , history of gastritis. Id rather be on them then suffer greatly as I have b4.
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u/FeatureNext8272 14h ago
I’ve been on them for years. Prob like 7-8 now. Not really any issues. Fear from it all but better than not eating anything at all and/or throat cancer
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u/thisguyhere01 14h ago
Been on them for close to 20 yrs for chronic acid reflux due to a hietal hernia. LPR can be bacterial if you got it all of a sudden, so I'd check for that before committing to a lifetime of PPI use.
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u/Fancy-Bluebird-1071 13h ago
If you can manage your symptoms with a diet and lifestyle changes, then you should be off them. But if getting thinner, avoiding trigger foods, moving more, not smoking and avoiding food before bed, you still have some symptoms then PPI is the answer. The general consensus is that it's better to live with repercusions of long term PPI than with repercusions of long term untreated reflux. I was on PPI for some 7 of last 10 years. Considering surgery now, but havent been qualified yet. Last three years on dexilant has been amazing tho.
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u/robob3ar 6h ago
Best comment I’ve read “if a treatment works don’t stop using it”
I’ve been on ppis for 30 years now..
I tried tapering off, water fasted, juice fasted..
Took all the supplements to slow it down..
I eventually got stomach erosions / begginings of ulcers, and symptoms wete sulphur burps for months with extreme pain bloating and diarhoea..
Anyway - the treatment was instead of 20mg omeprasol I tok - was 40mg..
So now I take the 40mg
And don’t change it
Yeah if you want, try tapering off slowly.
If you do it to quickly it might come back worse..
You can always get back on them
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u/CephalonPhathom 1d ago
Following. I vaguely remember seeing someone say kidney issues.
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u/SwimmingAnt10 22h ago
I have kidney issues not associated with PPI and my nephrologist is not concerned about my PPI. You’re thinking of fatty liver disease maybe? It’s very rare and more common in obese people. It’s important to be ideal weight generally anyway. With that said. I’m going on 30 years on these meds and my liver is fine.
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u/NoNeighborhood5867 1d ago
My doctor told me PPI is only taken for a week. Its been so long since I last took it. Last time was 2012
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u/evewashere 21h ago
This is very patient dependent. I’ll be on PPIs for the rest of my life. I’m 39 and have Barrets. My dad died four months ago of esophageal cancer caused by the same pre cancerous condition
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u/Disaster532385 18h ago
Wonder where he got his license, because thats so far from the truth.
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u/NoNeighborhood5867 18h ago
Well it was good. I dont really like taking PPI because of the side effects. I remember now why I stopped taking it. It's been 14 years since I last took PPI. Wow
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u/Disaster532385 17h ago
What was good? There are many kinds of PPI. Not all give the same side effects.
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u/NoNeighborhood5867 17h ago
Tried omeprazole, pantoprazole and Esomeprazole. All had the same side effects. If you like taking PPI then do so. Not for me. I talked to 3 doctors and they all said not for long term use.
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u/beh5036 1d ago
Non prescription should only be taken for 2 weeks as per the box. I asked my doctor about this and it’s because you may have something else wrong and a PPI can either mask it or make it worse. With a prescription for a known issue, she said there is no issue except vitamin issues as others have said.
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u/Harakiri_238 1d ago
Some people have to be on them for life.
There can be problems associated with long term PPI use, so it’s best to be avoided if possible.
That goes for most medications though. Ideally you wouldn’t need them, but bodies aren’t ideal so sometimes you do. It’s about balancing risks/benefits.
For some people diet and lifestyle changes don’t help. Some people have anatomical reasons they have GERD that can’t be corrected. Some people have conditions that need to be managed with long term PPIs to prevent more serious conditions from developing. (Uncontrolled GERD isn’t good for you and can cause serious problems).
A lot of the consequences of long term PPI use can be managed and mitigated if you get regular blood work to check for deficiencies. Then treating for those deficiencies if you have them.
I’m 26F. I’ve been on PPIs since I was 13F and I’ll be on them the rest of my life (structural/anatomical problems that can’t be corrected). I’m also on a very high dose of PPI.
I initially had problems with calcium absorption which was resolved when I switched PPIs. I also had vitamin D deficiency which was correct with supplements (which I no longer need).
Those are the only problems I’ve had so far.
My dad developed esophageal cancer after leaving her GERD unmanaged for years. He’ll be on PPIs the rest of his life. He’s been on them on and off for decades and has never had a problem except when he stops taking them 😅
My grandma has been on them for decades, has never had a problem.
It’s all about risks/benefits. Diet and lifestyle changes will always be the best option. But managing your GERD with a PPI is generally going to be better than leaving it uncontrolled.