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Proton Pump Inhibitor (PPI) Alternatives

There may be several alternatives available to patients taking proton pump inhibitors (PPIs) for the treatment of acid reflux and related conditions. Patients should discuss all of their treatment options with their doctor prior to making a decision about their health care.

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Proton pump inhibitors (PPIs) are commonly used to treat symptoms and complications of acid reflux (GERD) and stomach ulcers. But long-term PPI use has been linked to serious side effects. Patients suffering from these conditions, and their doctors, sometimes opt for alternatives to taking PPIs such as Prilosec and Nexium.

PPI alternatives can include minor lifestyle changes and nonmedical treatments; antacids and other non-PPI medications; and surgical interventions, ranging from minor endoscopic and laparoscopic procedures to open surgery.

The following information is intended to provide patients with an overview of what alternative treatments exist, and how they can help relieve symptoms.

Patients should speak with their doctor prior to stopping any medications or making changes to their current therapeutic regimen.

Lifestyle Modifications

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Patients can make several lifestyle changes to help manage the symptoms of acid reflux or GERD (gastroesophageal reflux disease).

Certain foods and drinks, including alcohol, can aggravate the condition by reducing lower esophageal sphincter (LES) pressure thereby allowing stomach acid to back up into the esophagus.

The most common irritants include caffeine (i.e. coffee, tea and chocolate), citrus fruits, pineapple, tomato-based foods (i.e. pizza, chili and spaghetti) and peppermint. Certain pain medicines can aggravate symptoms as well.

Successful Modifications
Other modifications that have proven successful include losing weight if overweight; exercising (not right after eating), especially yoga; eating smaller meals more often; and reducing stress, which can increase stomach acid and slow digestion.

Patients should also avoid smoking and chewing tobacco. Not wearing tight-fitting clothes, remaining upright for three to four hours after eating and elevating the head and upper body in bed can help relieve symptoms as well.

Nonmedical Treatments

Some nonmedical treatments may aid patients in symptom relief. The following chart can be used as a guide in evaluating one’s options. These methods are not FDA-approved treatments for the conditions PPIs treat.

Patients should speak with their doctor if symptoms do not improve, or get worse over time.

Some nonmedical treatmenst and how it can help
Acupuncture
Decreases stomach acid and symptoms of GERD and improves lower esophageal sphincter (LES) functioning.
Melatonin
Reduces pain, LES pressure and acid levels in the stomach.
Hypnotherapy (clinical hypnosis)
Reduces abdominal pain, unhealthy bowel patterns, bloating and anxiety.
Herbal remedies
Herbs that may be helpful in treating GERD include: Chamomile, Ginger root, Marshmallow root, Slippery elm. Clinical research on definitive benefits is lacking.
Baking Soda
Temporarily neutralizes stomach acid, relieves symptoms.

Antacids, H2 Blockers and Other Medicines

Antacids are over-the-counter medicines typically used as needed to treat symptoms of occasional heartburn or indigestion.

Fact
While antacids help to neutralize the stomach acid, they do not treat irritation in the esophagus associated with acid reflux (GERD).

Liquid antacids work faster than the tablets, but all forms of the medication work equally well.

Different types of antacids, however, may cause different side effects. Antacids containing magnesium are more likely to cause diarrhea, while those with calcium or aluminum may cause constipation.

In rare cases, antacids with calcium can cause kidney stones, while those with aluminum can result in calcium loss, which can lead to weakened bones (osteoporosis).

Patients should also use caution when taking other medicines along with antacids, as they can change the way the body absorbs certain substances.

Antacids may not be recommended for patients with certain health conditions, such as kidney disease, high blood pressure and heart disease.

Histamine Blockers

Histamine blockers, or H2 blockers, were the drug of choice for acid reflux (GERD) prior to the introduction of proton pump inhibitors (PPIs).

Although PPIs were found to be more effective in treating symptoms and complications associated with GERD, H2 blockers have proven to be just as effective in suppressing gastric acid.

H2 blockers are available by prescription or over-the-counter, and include ranitidine, famotidine, cimetidine and nizatidine. Common side effects include nausea, vomiting or upset stomach.

Histamine blocker diagram
Diagram showing how H2 blockers reduce Gastric Acid

Antibiotics

Patients diagnosed with ulcers caused by an infection resulting from the bacteria called Helicobacter pylori (H. pylori), can generally be treated with antibiotics.

H. Pylori
H. pylori can irritate the lining of the stomach causing erosion. Acid can then cause further damage to the already weakened stomach tissue resulting in an ulcer.

Antibiotics shown to be the most effective in treating H. pylori infection include amoxicillin, tetracycline, metronidazole or clarithromycin.

Patients with H. pylori infections may be prescribed one or two antibiotics, or a combination of antibiotics and other medicines used to treat ulcers and reduce acid in the stomach.

Cytoprotective Drugs

Cytoprotective drugs provide a coating in the stomach and small intestine, preventing stomach acid from causing damage to the stomach lining.

Drugs in this class include sucralfate, misoprostol and bismuth subsalicylate, commonly known as Pepto-Bismol.

Sucralfate and misoprostol require a prescription, but Pepto-Bismol is available over-the-counter.

When taken during pregnancy, misoprostol has been shown to cause miscarriage. Sucralfate, however, is commonly prescribed in pregnant women with GERD because it has not been shown to cause any adverse effects to the mother or the fetus.

What are some alternatives to proton pump inhibitors?
Certified health practitioner Rebecca Montrone discusses alternatives to PPIs

Surgical Intervention

Anti-reflux surgery is sometimes used when lifestyle changes and medicines used to treat GERD prove to be unsuccessful.

Patients and their doctors may choose between several different surgical techniques, including open surgery, surgery using a laparoscope and smaller incisions, or surgery with an endoscope with no incision.

The most common surgical procedure for GERD is called fundoplication. Fundoplication involves wrapping the upper stomach around the end of the esophagus and sewing it into place.

This results in the lower part of the esophagus passing through a small tunnel of stomach muscle, creating pressure that prevents stomach acid and food from flowing up from the stomach and into the esophagus.

Please seek the advice of a medical professional before making health care decisions.

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7 Cited Research Articles

  1. Fass, R. (2012, August). Alternative Therapeutic Approaches to Chronic Proton Pump Inhibitor Treatment. Clinical Gastroenterology and Hepatology. Volume 10, Issue 4, Pages 338-345. Retrieved from http://www.cghjournal.org/article/S1542-3565(11)01335-8/fulltext
  2. Pritchard, J. (2017, August 14). Alternatives to Proton Pump Inhibitors. Livestrong.com. Retrieved from https://www.livestrong.com/article/147919-alternatives-to-proton-pump-inhibitors/
  3. Kerr, M. and Nall, R. (2017, August 8). What Complementary and Alternative Medicines Work for Acid Reflux? Healthline. Retrieved from https://www.healthline.com/health/gerd/alternative-treatment#see-a-doctor
  4. U.S. National Library of Medicine. NIH. (2016, December 8). Gastroesophageal reflux – discharge. MedlinePlus. Retrieved from https://medlineplus.gov/ency/patientinstructions/000197.htm
  5. U.S. National Library of Medicine. NIH. (2016, February 27). Anti-reflux surgery. Medline Plus. Retrieved from https://medlineplus.gov/ency/article/002925.htm
  6. U.S. National Library of Medicine. NIH. (2016, December 8). Taking antacids. Medline Plus. Retrieved from https://medlineplus.gov/ency/patientinstructions/000198.htm
  7. Centers for Disease Control and Prevention. (2006, September 28). Helicobacter pylori and Peptic Ulcer Disease: The Key to Cure. Retrieved from https://www.cdc.gov/ulcer/keytocure.htm or https://www.cdc.gov/ulcer/files/hpfacts.PDF
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