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Heartburn: acid blockers with side effects

Status: 23.10.2018 10:27 a.m. | archive
For heartburn, many sufferers take so-called acid blockers.

For heartburn, many people take acid blockers for the stomach called proton pump inhibitors (PPIs). For a long time the tablets, which were also sold over the counter in low doses, were considered to be relatively harmless. But more is now known about possible side effects: People who regularly take proton pump inhibitors, for example, are more prone to broken bones and intestinal infections. In addition, acid blockers can make the stomach more sensitive than calming it down.

What is heartburn?

Heartburn is an uncomfortable and often painful feeling behind the breastbone. If it recurs, heartburn can lead to bleeding, narrowing or scarring of the esophagus, especially in elderly patients, and in rare cases it can even cause cancer.

Inadequate closure of the gastric entrance

The cause is insufficient closure of the stomach entrance. If the sphincter muscle relaxes, the gastric juice flows repeatedly into the esophagus and burns it. Sufferers should sleep slightly higher so that this reflux does not occur. Obese people should lose weight to reduce the pressure on the stomach.

Side effects of proton pump inhibitors

Because of their effectiveness in treating heartburn, proton pump inhibitors such as omeprazole or pantoprazole are often prescribed and taken. They work on the acid-producing cells in the stomach for 36 hours each and lower the acid level. For a long time, proton pump inhibitors were considered well tolerated and harmless. However, a permanent lowering of the acid value can lead to undesirable side effects:

  • The body absorbs some nutrients more poorly. A lack of calcium increases the risk of breaking bones. A deficiency in magnesium and vitamin B12 can also arise. Possible consequences are concentration disorders, paralysis and anemia.
  • If stomach acid does not kill bacteria, they can settle in the intestines and cause diarrhea.
  • Some research suggests that proton pump inhibitors increase the risk of heart attack and damage to the liver and kidneys.
  • Acid blockers may even promote dementia in older people: in a study, seniors who took proton pump inhibitors for a long time were 44 percent more likely to develop dementia than subjects in the control group.

When are proton pump inhibitors useful?

The number of proton pump inhibitor doses has tripled in the past decade. Experts assume that by no means all people who regularly take acid blockers really need them or benefit from them.

Stomach acid blockers should only on medical advice be taken. First, two hours before a meal, a high dose is tried out to see whether the drug works at all and eliminates the symptoms. Then the doctor reduces the dose as much as possible in order to keep the dosage as low as possible.

If unclear gastrointestinal complaints occur, the tablets should be discontinued after consulting a doctor. So-called antacids, which bind stomach acid, can be an alternative. But they are not as effective as PPIs.

Proton pump inhibitors are useful for one Reflux diseaseif it has already caused changes to the esophagus and for people who regularly take anticoagulants and pain relievers in combination to reduce the risk of bleeding in the stomach and intestines.

Slowly discontinue acid blockers

If you take proton pump inhibitors for more than four weeks and then suddenly stop taking them, you risk a so-called rebound effect. That means: The body reacts with a temporarily particularly strong gastric acid production. Therefore, the acid blocker dose must be reduced slowly over a longer period of time.

Tips for the occasional heartburn

Those who only occasionally suffer from heartburn can reduce the symptoms by:

  • Drink a lotto wash down the gastric juice in the esophagus, whether with milk, tea, or water. The drink should not contain carbon dioxide.
  • Healing earthcan bind stomach acid. Alternatively, chew oatmeal and almonds finely and swallow. Soda, on the other hand, has had its day as a home remedy: it cannot, as previously assumed, neutralize stomach acid.
  • No heavy ones Meals in the evening, they affect the quality of sleep and thereby promote heartburn. If you have eaten late, you should sleep on your left side because gastric juice does not then flow easily into the esophagus.
  • With slightly raised upper body sleep.
  • On Smoke and alcohol do without if possible.
  • Mint tea Avoid: It can weaken the sphincter muscle at the stomach entrance and promote heartburn.

Regular meals, little coffee and carbon dioxide, no spicy or fatty foods, few sweets, no citrus beverages, little stress and adequate sleep are helpful for heartburn.

Heartburn surgery

If the symptoms cannot be alleviated by stomach acid blockers, weight loss and proper nutrition, surgery may be necessary in rare cases:

  • The conventional method is the so-called Cuff surgery. It is usually carried out in a minimally invasive manner using the keyhole technique. The procedure has been established for years. Nevertheless, the procedure is technically demanding. The upper part of the stomach is placed around the lower sphincter of the esophagus like a cuff and sutured. The cuff strengthens the sphincter and narrows the entrance to the stomach, preventing gastric acid from flowing back. The success rate of the operation is around 90 percent. About ten percent of those affected have difficulty swallowing after the procedure.
  • In a more recent process, a Magnetic tape placed around the stomach entrance. The magnetic pearls attract each other and thus ensure that the stomach entrance is closed. This procedure is also carried out in a minimally invasive manner. Although the ligament opens when swallowing, swallowing disorders often occur here too. In addition, the ligaments can grow in and scar. The cost of the operation will only be covered by the health insurances upon request. Up to now, around 400 patients in Germany have worn such a magnetic tape. It remains to be seen whether the method has a similarly high success rate as the classic surgical technique.
  • With a Pacemaker Another method of treating chronic heartburn is available. Two electrodes are connected to the sphincter at the entrance to the stomach. They are connected to a stimulator that is implanted under the skin of the abdominal wall. It can be programmed from the outside through the skin and then sends pulses to the sphincter muscle at regular intervals. The weak electrical impulses strengthen the sphincter and should restore its function in the long term. However, it can take up to six months for the muscle to respond properly to the pacemaker. The pacemaker system has been implanted around 1,500 times worldwide in recent years. The first results are promising, but there are no long-term results here either. The health insurance companies only cover the costs for this procedure upon request.

Diet for heartburn

A lot of protein, little sweets, rather small meals instead of two or three large ones - that protects the stomach and esophagus. Also important: eat dinner early before lying down. more

Experts on the subject

Prof. Dr. Jürgen Pohl, chief physician
Gastroenterology
Asklepios Clinic Altona
Paul-Ehrlich-Strasse 1
22763 Hamburg
(040) 18 18-81 12 00
www.asklepios.com

Prof. Dr. Tobias Welte, chief physician
Pneumology Clinic
Hannover Medical School
Carl-Neuberg-Strasse 1
30625 Hanover
www.mh-hannover.de

Priv.-Doz. Dr. Oliver Bachmann, senior physician
Clinic for Gastroenterology, Hepatology and Endocrinology
Hannover Medical School
Carl-Neuberg-Strasse 1
30625 Hanover
(0511) 532-31 60
www.mh-hannover.de

Prof. Dr. Joachim Röther, chief physician
neurology
Asklepios Clinic Altona
Paul-Ehrlich-Strasse 1
22763 Hamburg
(040) 18 18-81 14 01
www.asklepios.com

Prof. Dr. Pia Pogoda, senior physician
Institute for Osteology and Biomechanics
Center for Experimental Medicine
University Medical Center Hamburg-Eppendorf
Lottestrasse 59
22529 Hamburg
www.uke.de

additional Information
German society for combating diseases of the stomach, intestines and liver as well as disorders of metabolism and nutrition (Gastro-Liga) e. V.
Friedrich-List-Strasse 13
35398 casting
(0641) 9 74 81-0
www.gastro-liga.de

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