Some treatment options for PPIs
DEAR DOCTOR: Because of the potential risks of proton pump inhibitors, should I have an H. pylori breath or stool test to make sure I have this bacterium before committing to long-term treatment with a PPI?
DEAR READER: First identified in 1982, Helicobacter pylori is a bacterium that causes chronic inflammation of the stomach lining and stomach, as well as duodenal ulcers; it can also lead to gastric cancer and a slow-growing type of cancer known as MALT lymphoma. In fact, H. pylori is the most common chronic bacterial infection in humans. As for PPIs, they can cause deficiencies in some nutrients and increase the risk of infection with the bacterium C. difficile.
Because these PPIs (Nexium, Prilosec, Prevacid, Aciphex, Protonix, Dexilant) decrease the acidity in the stomach, allowing for healing of inflamed tissues, they’re used to treat inflammation in the stomach; ulcers of the stomach or the duodenum; and acid reflux.
Whether you should take PPIs long-term depends on your condition. In most cases for which the medication is prescribed long-term, you
would have an endoscopy to visualize the esophagus, stomach and the duodenum (first portion of the small intestine).
If you didn’t have an endoscopy and have been diagnosed with gastritis, then I would recommend checking for H. pylori. If you’re infected, you could be treated with antibiotics instead of a long-term PPI.
If you’re considering taking a PPI long-term for acid reflux (heartburn), there has been no proof that treating an H. pylori infection would improve the acid reflux unless you had an ulcer in the duodenum. Regarding acid reflux, you should first look at stopping cigarette smoking, alcohol, caffeine and chocolate before considering long-term use of a PPI.
In summary, if your doctor diagnoses you with gastritis, an H. pylori stool test would be of benefit. If your doctor suspects an ulcer, then I would recommend getting an endoscopy, during which you would be tested for H. pylori.
Robert Ashley, M.D., is an internist and assistant professor of medicine at the University of California, Los Angeles.