Proton pump inhibitor in the review: alternatives to gastric acid blockers

What sounds like a component from the warp drive of the spaceship Enterprise is one of the world's most prescribed drugs: proton pump inhibitors. Since the market launch of gastric acid blockers in 1988, the number of daily doses prescribed by physicians in Germany has risen to an incredible 3683 million in 2015 (according to the 2016 Medicinal Declaration Report). But for some time there is increasing criticism of the supposed miracle drug loud, which is regularly prescribed for every sixth German according to a study of BARMER health insurance. But before we turn to this for and against, let's take a look at the function of stomach and stomach acid.

Gastric Acid: Aggressive but important

The proton pump (actually proton potassium pump) is, unlike the name suggests, not an organ, but refers to an enzyme with the bulky name H + / K + -ATPase. This enzyme is located in the so-called parietal cells of the stomach and is responsible for the transport of protons out of the cell and the transport of potassium into the cell. Gastric juice, better known as stomach acid, is formed (greatly simplified) in this process. And in a big way: Every day in the stomach about two to three liters of gastric acid are produced. The hydrochloric acid contained therein causes an acidic gastric environment with a pH of about 1 to 1.5. If the stomach were not lined with the protective gastric mucosa from the inside, it would decompose through the aggressive gastric acid and virtually digest itself.

The formation of gastric acid distinguishes three phases. First comes the? Head phase? (Cephale phase): Even the sight of food can trigger the production of stomach acid, as well as a sound like cutlery rattle or the smell of a roast. These sensory stimuli are passed on from the vegetative nervous system, the parasympatheticus, to the stomach, which then knows: Attention, there's something to digest! It follows the? Stomach phase? (Gastric phase), during which the largest amount of gastric acid is produced as soon as the stomach is filled with food and the stomach wall is stretched. When the porridge reaches the duodenum, the intestinal phase begins? (Intestinal phase), while the hormones ensure that the production of stomach acid is shut down again.


When this complex system is in balance, stomach acid does exactly what it should: it helps to break down and digest the food. In addition, it kills unwanted germs and has a bactericidal effect. However, if the parietal cells of the stomach produce too much stomach acid, this is called gastric acidity (hyperacidity). The most common causes of this are an unhealthy diet, caffeine, nicotine, stress and the frequent intake of stomach irritant drugs. If this acidity lasts longer, it can lead to gastritis (gastritis) or gastric or duodenal ulcer. If a part of the gastric acid enters the esophagus (reflux), heartburn and long-term damage to the oesophageal mucosa result. Exactly these symptoms should alleviate proton pump inhibitors or even better avoid them. But especially with heartburn this bill does not work out.

The mode of action of proton pump inhibitors

As the name suggests, proton pump inhibitors (PPI for proton pump inhibitor) inhibit the proton pump. The drug is absorbed in the intestine and then enters the blood stream into the stomach and parietal cells, which then stop or significantly reduce the production of stomach acid. The active ingredients in PPI are omeprazole, esomeprazole, pantoprazole, lansoprazole, or rabeprazole. If you take a stomach medicine and you do not know exactly if it is PPI (for example, Antra MUPS, Nexium, Lanzor, or Rifun), it should be written on the package insert after the suffix? -Prazole? search. And if you have the note in your hand, it's also worth taking a look at the side effects, which are abundant. For a stomach drug the most surprising is the list of (possible) side effects diarrhea, nausea, vomiting, flatulence, constipation and abdominal pain and discomfort. The heartburn is gone, but otherwise ??

Once PPI, always PPI?

The regular intake of PPI carries the risk of dependence on the drug. This does not mean mental addiction, but the physical effects of the so-called rebound effect. If the parietal cells are prevented from producing gastric acid for a long time by PPI, they react to the discontinuation of the drug with significantly increased activity. The result: More stomach acid is released than before taking and the symptoms such as heartburn are immediately back. Of course, help PPI and the circle closes.


PPI only with clear diagnosis

Doctors who quickly wave a PPI prescription on frequent heartburn should reconsider their prescribing tactics.Wolfgang Becker-Brüser, publisher of the journal "arznei-telegramm? says: "In a clear diagnosis such as an ulcer (gastric ulcer), the benefit is clearly proven. But when there is no clear reason to prescribe the funds, the risks come to fruition. And that the funds are prescribed quickly and often without good reason, a study of the drug commission of the German medical profession to 500 patients: In 58 percent of cases could be no meaningful reason for a further regulation.

Alternatives to PPI

Especially uncomfortable heartburn is one of the most common reasons for taking PPI. These solve the problem but only in the short term and lead to weaning rather to an aggravation of the complaints. Alternative methods and remedies for heartburn are:

  • avoid anything that has caused heartburn before taking PPI
  • Healing earth or bentonite (mineral earth)
  • soaked psyllium seeds or flaxseed
  • the juice of a grated and squeezed potato
  • some chewed almonds and swallowed in small portions
  • the chewing of unsweetened gum (the produced saliva protects the esophagus)
  • many small meals instead of less big ones
  • little coffee, black tea, alcohol or carbonated drinks, more still water and herbal teas (such as chamomile or ginger)

Those who want to do something conventional for heartburn should resort to so-called antacids for the neutralization of gastric acid, for example Rennie or Maaloxan.

Mayo Clinic Minute: Balancing Proton Pump Inhibitor Risks and Benefits | March 2024