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Proton Pump Inhibitor (PPI) Alternatives

Proton pump inhibitor (PPI) alternatives can include other medicines like H2 blockers or natural remedies like lifestyle changes. Alternatives to PPIs may help treat acid reflux and related conditions. But they may not help everyone. People should ask their doctors if PPIs are the best option for their condition or whether PPI alternatives will work for them.

Proton pump inhibitors (PPIs) are powerful heartburn drugs. They treat gastroesophageal reflux disease (GERD) and stomach ulcers. Over-the-counter (OTC) versions treat frequent heartburn.

But studies and PPI lawsuits link long-term PPI use with serious side effects. Concerns over proton pump inhibitor side effects may lead patients to seek alternatives to PPIs.

There are three types of medicines that treat symptoms like heartburn. These include proton pump inhibitors such as esomeprazole (Nexium), omeprazole (Prilosec), pantoprazole (Protonix) and lansoprazole (Prevacid). The others are antacids such as Maalox, Mylanta and Tums; and H2 (histamine) receptor antagonists such as ranitidine (Zantac), famotidine (Pepcid), and cimetidine (Tagamet).

Some people may be able to manage their symptoms with nonmedical or natural treatments. Others may turn to surgical options.

PPI Alternatives Can Include
  • Antacids
  • Other non-proton pump inhibitor medicines
  • Lifestyle changes
  • Nonmedical or natural treatments
  • Surgery

Patients on PPIs should speak with their doctor before stopping PPIs. They should also talk to their doctor before switching to a PPI alternative. Alternatives to proton pump inhibitors may not work for some conditions PPIs treat.

At the same time, PPIs are among the most overused and misused medicines in America. Studies have found many people take proton pump inhibitors for the wrong condition.

Proton pump inhibitors may also interact with other drugs a person is already taking.

Nonmedical & Natural Alternatives to PPIs

There are several nonmedical or natural alternatives to proton pump inhibitors. These methods are not FDA-approved treatments for the conditions PPIs treat.

These remedies may not work for everyone taking PPIs. They may also aggravate some conditions PPIs treat. Patients should speak with their doctor if symptoms do not improve or get worse.

Nonmedical or Natural Proton Pump Inhibitor Alternatives Include
Acupuncture
The alternative medicine decreases stomach acid and symptoms of GERD. It improves lower esophageal sphincter (LES) functioning.
Melatonin
The hormone reduces pain, lower esophageal sphincter (LES) pressure and acid levels in the stomach.
Hypnotherapy (clinical hypnosis)
The method reduces abdominal pain, unhealthy bowel patterns, bloating and anxiety.
Herbal remedies
Chamomile, ginger root, marshmallow root and slippery elm may be helpful in treating GERD. But clinical research on definitive benefits is lacking.
Baking soda
The household product may provide temporary relief by neutralizing stomach acid.
Chewing gum
Some small studies have found chewing gum after meals appears to reduce acid levels.
Aloe juice
A small 2015 study of 79 people found Aloe vera was “safe and well tolerated” in treating GERD patients. Researchers said Aloe vera “may provide a safe and effective treatment” for symptoms.
Almonds
Research is lacking on how effective almonds are at relieving GERD symptoms. Unlike other nuts that are acidic, almonds are generally alkaline. This may help counteract stomach acid.

PPIs & Lifestyle Modifications

Several lifestyle changes can help people manage the symptoms of acid reflux. These may be as simple as changing clothing styles. But they may also require people to give up favorite foods or lose weight.

Lifestyle Changes as PPI Alternatives Include
  • Not using tobacco
  • Losing weight (maintaining a BMI of 24 or less)
  • Exercising regularly
  • Sleeping on the left side
  • Elevating the head and upper body in bed
  • Wearing loose fitting clothes
  • Eating five to six small meals a day

Can Antacids Work as an Alternative to PPIs?

Antacids are over-the-counter medicines that treat occasional heartburn or indigestion. They help neutralize stomach acid.

They may relieve some acid reflux symptoms. But they do not treat irritation in the esophagus associated with acid reflux (GERD).

Popular Antacids
  • Alka-Seltzer
  • Gaviscon
  • Maalox
  • Milk of Magnesia
  • Mylanta
  • Peto-Bismol
  • Rolaids
  • Tums

Liquid antacids work faster than tablet versions. But all forms of the medication work about the same.

Antacid side effects are rare. They can differ based on the medicines’ ingredients.

Rare Antacid Side Effects
Antacid Ingredient Possible Side Effect
Magnesium Diarrhea
Aluminum Constipation Calcium loss,
osteoporosis
Calcium Constipation
Kidney stones

Doctors may not recommend antacids for patients with certain health conditions. These include kidney disease, high blood pressure and heart disease.

Histamine (H2) Blockers vs. PPIs

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.

Popular H2 Blockers
  • Zantac (ranitidine)
  • Pepcid, Pepcid AC (famotidine)
  • Tagamet (cimetidine)
  • Tazac, Axid (nizatidine)

PPIs and H2 blockers work in different ways. PPIs block tiny pumps in the stomach that produce acid. H2 blockers block histamine.

Histamine is one of the earliest stimuli that tell the stomach to produce acid. H2 blockers work within an hour. PPIs may take up to four days to start working.

Diagram showing how H2 blockers reduce gastric acid
H2 blockers work to reduce gastric acid.

Common H2 blocker side effects include nausea, vomiting or upset stomach. These are also some of the more common proton pump inhibitor side effects.

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Cytoprotective Drugs

Cytoprotective drugs coat the stomach and small intestine. The protective coating prevents stomach acid from damaging the stomach lining.

Cytoprotective Drugs Include
  • Sucralfate (Carafate, Orafate, ProThelial)
  • Misoprostol (Cytotec)
  • Bismuth subsalicylate (Pepto-Bismol, Kaopectate)

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

When taken during pregnancy, misoprostol may cause miscarriage. Sucralfate is safer for pregnant women with GERD. Research has not shown it to cause any adverse effects to the mother or the fetus.

 
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Replay Video
Certified health practitioner Rebecca Montrone discusses alternatives to PPIs.

Antibiotics & PPI Alternatives for Ulcers

PPIs have played a key role in treating ulcers caused by infection. They have largely replaced H2 blockers as an acid-reducer in the treatment.

Bacteria called Helicobacter pylori (H. pylori) can irritate the stomach lining. Acid is then able to erode the stomach area around the infection. This dual action weakens the stomach lining, causing an ulcer.

Proton pump inhibitors reduce stomach acid. And the antibiotics kill H. pylori bacteria. The combination gives ulcers time to heal.

Doctors prescribe a combination of two or more antibiotics to attack the bacteria.

Antibiotics Used to Treat H. pylori Infections
  • Amoxicillin
  • Clarithromycin
  • Metronidazole
  • Tetracycline (in patients 12 or older only)

Before PPIs, doctors prescribed H2 blockers or other acid reducers. Treatment guidelines now recommend PPIs as the first choice.

PPI Alternatives for H. pylori Treatment
  • Ranitidine bismuth citrate (Tritec)
  • Bismuth subsalicylate (Pepto-Bismol, Kaopectate)

Surgical Intervention or Proton Pump Inhibitors

Surgery is an option if PPIs and other alternatives fail to relieve GERD symptoms. Doctors may recommend one of several types of procedures.

Surgical Alternatives to PPIs
LINX surgery
A surgeon places a ring of tiny, magnetized titanium beads around the lower esophagus. The ring prevents acid from pushing from the stomach up into the esophagus.
Nissen fundoplication
A surgeon wraps the top part of the stomach 360 degrees around the lower part of the esophagus.
Partial fundoplication
A surgeon wraps the top part of the stomach partway around the lower part of the esophagus. The wrap may range from 180 to 200 degrees depending on which technique the surgeon chooses.
Gastropexy
A surgeon sutures the stomach to the abdominal wall or the diaphragm. This prevents the stomach from moving into the chest.

When to See a Doctor for GERD

In some cases, PPI alternatives will not work. People who continue to experience acid-related problems should talk to their doctor.

The conditions PPIs treat are serious health conditions. Left untreated, they can cause lasting and even life-threatening damage.

Seek Medical Attention for These Symptoms
  • Diarrhea or black bowel movements
  • Difficulty swallowing
  • GERD symptoms that cause chest pain
  • Heartburn that causes nausea or vomiting
  • Discomfort that needs OTC medicine more than twice a week

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

Terry Turner
Written By Terry Turner Writer

Terry Turner has been writing articles and producing news broadcasts for more than 25 years. He covers FDA policy, proton pump inhibitors, and medical devices such as hernia mesh, IVC filters, and hip and knee implants. An Emmy-winning journalist, he has reported on health and medical policy issues before Congress, the FDA and other federal agencies. Some of his qualifications include:

  • American Medical Writers Association (AMWA) and The Alliance of Professional Health Advocates member
  • Centers for Disease Control and Prevention Health Literacy certificates
  • Original works published or cited in Washington Examiner, MedPage Today and The New York Times
  • Appeared as an expert panelist on hernia mesh lawsuits on the BBC
Edited By
Medically Reviewed By
Venkatachala Mohan, MD
Dr. Venkatachala Mohan Internal Medicine, Gastroenterology

14 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
  8. Panahi, Y. et al. (2015, December). Efficacy and Safety of Aloe Very Syrup for the Treatment of Gastroesophageal Reflux Disease: A Pilot Randomized Positive-Controlled Trial. Journal of Traditional Chinese Medicine. Retrieved from https://www.ncbi.nlm.nih.gov/pubmed/26742306
  9. O’Connor, A. (2011, January 13). Remedies: Chewing Gum for Heartburn. New York Times. Retrieved from https://well.blogs.nytimes.com/2011/01/13/remedies-chewing-gum-for-heartburn/
  10. Centers for Disease Control and Prevention. (206, September 28). Helicobacter pylori and Peptic Ulcer Disease; The Key to Cure. Division of Bacterial Illnesses. Retrieved from https://www.cdc.gov/ulcer/keytocure.htm
  11. Kim, S.Y., Choi, D.J. and Chung, J. W. (2015, November 6). Antibiotic Treatment for Helicobacter pylori: Is the End Coming? World Journal of Gastrointestinal Pharmacology and Therapeutics. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4635158/
  12. Medical University of South Carolina. (n.d.). LINX Reflux Management. Retrieved from http://ddc.musc.edu/public/surgery/laparoscopic/linx.html
  13. Cheung, K.S. et al. (2017, October 31). Long-Term Proton Pump Inhibitors and Risk of Gastric Cancer Development After Treatment for Helicobacter pylori: A Population-Based Study. BMJ, Gut. Retrieved from https://gut.bmj.com/content/early/2017/09/18/gutjnl-2017-314605.info
  14. Gawron, A.J. et al. (2012, February 23). Many Patients Continue Using Proton Pump Inhibitors After Negative Results from Tests for Reflux Disease. Clinical Gastroenterology and Hepatology. Retrieved from https://www.cghjournal.org/article/S1542-3565%2812%2900215-7/abstract
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