More than 30 years ago, specifically in 1988, the first proton pump inhibitor (PPI) drug appeared in Spain: the famous omeprazole. A product that, unlike other previous medications, had great efficacy and safety in the treatment of stomach and duodenal ulcers and gastroesophageal reflux.
It was the beginning of a pharmacological revolution in this field to which more drugs from the same family (lansoprazole, pantoprazole, esomeprazole …) were added over time. Today, PPIs are among the most widely used drugs in Spain and other Western countries.
Their popularity is such that they are fully integrated into our culture, under the name “gastric protectors.” However, what is the reality behind the nickname of these drugs?
“Gastric protectors”: a misnomer
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As their name suggests, drugs in this family work by blocking proton pumps in the stomach. These pumps are protein channels present in the cell membranes that line the surface of said organ and that release protons (H +) to acidify the gastric juice. Thanks to these pumps, the inside of the stomach can become very acidic (pH between 1.5 and 3.5), even more than lemon juice. When PPIs irreversibly inhibit these pumps, they stop releasing protons into the stomach cavity and, therefore, the pH increases (that is, the acidity decreases).
In short, PPIs drastically block acid production in the stomach and make gastric juice less acidic. This comes in handy when heartburn becomes a problem as in cases where stomach content passes into the esophagus (gastroesophageal reflux) or when there is damage to the mucosa that normally protects the stomach or duodenum from this juice (gastroduodenal ulcers).
PPIs do not actually protect the stomach, as they do not exert any function on the protective barrier of the stomach
Beyond these indications, PPIs are essential in the treatment to eradicate the Helicobacter pylori bacteria in combination with antibiotics and also for other much less frequent health problems such as Zollinger-Ellison syndrome in which an excess of induced acid is produced by tumors present in the stomach. In addition, in very specific circumstances, PPIs are prescribed to prevent stomach injury in people who consume certain medications that have the ability to damage the gastric mucosa under certain conditions (such as some anti-inflammatories or anticoagulants).
But … what do they do then?
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PPIs don’t actually protect the stomach, since they do not exert any function on the protective barrier of the stomach (the gastric mucosa) nor do they cover the surface of the stomach to defend it from various damages. These drugs simply decrease gastric acidity. Despite this, the rage for PPIs in everyday life has led to their excessive consumption by the general population, who idealize them as “gastric protectors.”
Many people believe that these drugs are useful for various stomach problems, beyond their original indications, described in the package insert. Thus, PPIs are consumed unjustifiably before large feasts to avoid suffering the dreaded indulgence, when consuming other medications (even if they do not cause stomach injuries) or for specific cases of burning or heartburn. In these cases, it is advisable to apply lifestyle measures (which solve almost all cases) and consume other specific medications for these situations such as the combination of salts and / or complexes of aluminum and magnesium.
The unjustified consumption of omeprazole in Spain
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Doctors are also partly responsible for the abuse of these heartburn drugs
The rise in the consumption of PPIs has been meteoric in Spain in just a few decades. Currently, omeprazole is, along with the popular ibuprofen and paracetamol, on the podium of the most widely used drugs in our country. Already in 2015, the Spanish Society of Primary Care Physicians warned that in 30% of the cases of omeprazole consumption it was not justified. In 2018, the media once again warned that between 54 and 69% of PPI prescriptions were inappropriate. It is estimated that around 85 people per 1,000 in Spain consume drugs such as omeprazole and its equivalents.
Although most PPI presentations require a prescription, since 2016 it is possible to get these medications without the need for her in the pharmacy. This has further fueled the irresponsible use of these drugs among the general population, for indications that are not scientifically supported.
Looking to blame for its historical misuse
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Doctors are also partly responsible for the abuse of these heartburn drugs. In Spain, PPIs are prescribed 70% above the European average. Many of the prescriptions for these drugs are not warranted. For example, it is not uncommon for PPIs to be prescribed to people who use certain drugs for fear of injury to the stomach when, in reality, those drugs are not gastro-injurious within the prescribed guidelines. These are sometimes prescribed chronically, when their use should be limited in time.
Besides idealizing their properties as “stomach protectors,” popular culture also underestimates the adverse effects of PPIs they can cause, especially when consumed long-term. Among the most frequent and acute unwanted effects (between 1 and 10 people in 100 who take these medicines) are headache, nausea, vomiting, diarrhea, constipation, gas, stomach pain …
The use of these medicines can lower the levels of magnesium in the blood.
In addition, drugs such as omeprazole can interact with a wide variety of drugs and in very rare cases can cause, among other problems, immunodeficiencies. In the long term, the use of these drugs can lower magnesium levels in the blood and has been associated with an increased risk of vitamin B12 deficiency, osteoporosis, fractures, digestive infections, stomach cancer …
A medicine that, used well, makes sense
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PPIs offer a great health benefit, with minimal risk, for those indications in which their efficacy has been demonstrated. In fact, the appearance of these drugs meant a revolution in the treatment of gastroduodenal ulcers. However, the balance changes totally when they are used for those health problems where they are not justified.
The generalized abuse of omeprazole in the population leads to the possible appearance of adverse effects, without its use showing any benefit and PPIs thus become a real risk to public health. Health education campaigns are necessary to tackle the erroneous beliefs that have become so widespread in our society about these drugs.