Dear Dr. Roach: You’re writing about PPIs like Prilosec, which I’ve been successful in fighting severe cases of GERD with small hiatal hernias for over a decade.
But what is your opinion about my long-term use (which was a true lifesaver) and keeping it essentially forever? My stomach specialist seems to be “keeping it” for its success, but are there any potential drawbacks, especially in renal function? Is it easy for the kidneys to switch to H2 blockers like Pepcid or Tagamet?
— — KJ
Dear KJ: All drugs have side effects, and it is worth regularly examining the risks and benefits of taking them for long periods of time. You already know its benefits: a significant improvement in your quality of life. The balance, on the other hand, is some potential risk.
The most obvious risk is probably an infection. Failure to make stomach acid carries the risk of Clostridium difficile infection (severe diarrhea) and possibly other infections, including pneumonia. Malabsorption of nutrients, especially magnesium and vitamin B12, is so frequent that tests may be appropriate for people taking PPI for long periods of time. Calcium can also be affected, which can increase the risk of osteoporosis. It also deserves screening for the appropriate people at risk.
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