According to new research—drugs that reduce gastric acid secretions, which include brand names such as Prilosec, Nexium, and Prevacid—not only kill and ingest microbes and suppress gastric acid secretions but they can change intestinal bacteria, which can promote the progression of liver disease.

Rising Cases of Liver Disease

Per the National Institute of Health, gastroesophageal reflux disease (GERD) affects about 20% of the U.S. population. And drugs that treat this are among the most commonly prescribed medications in the world and can be easily obtained over the counter at your local drug store. 

Approximately 6% to 15% of the general population take PPIs, or proton pump inhibitors, up to 32% with non-alcoholic fatty liver disease and up to 72% in those with cirrhosis take the acid-reducing drugs to block stomach acid secretions and relieve symptoms of frequent heartburn, acid reflux, and GERD. So, with the rising number of people with chronic liver disease in western countries and liver cirrhosis as end-stage organ disease now the 12th leading cause of death worldwide, could this be a side effect of PPI medication use? 

Possibly.

The UCSD study showed that PPI use increased the number of intestinal Enterococcus bacteria in mice. The translocating enterococci bacteria leads to liver inflammation and liver cell death. Notably, it was the expansion of intestinal Enterococcus faecalis (E. faecalis), which was enough to exacerbate alcohol-induced liver disease in mice.

Particular Issue for the Alcohol-Dependent

PPI use increases the risk of developing alcoholic liver disease among alcohol-dependent patients. Reduction of gastric acid secretion, therefore, appears to promote overgrowth of intestinal Enterococcus, which promotes liver disease, based on data from the mice models and humans.

This is definitely an undesired and adverse effect of PPIs, so it’s important to understand this and to consult with your doctor to ensure the necessity of these drugs. Occasional use of PPIs for acute or short-term problems typically should not be problematic, however, there are safety issues associated with long-term therapy.

The American Gastroenterological Association Institute recommends determining the least potent therapy that controls acute GERD and then continuing this therapy for eight weeks. After eight weeks, the consumer should be given a trial off the medication. If symptoms recur in fewer than three months, there may be a need for maintenance therapy. Maintenance therapy can be intermittent or continuous.

Your doctor may also recommend you have an upper endoscopy if there is doubt about the diagnosis or any other symptoms you may be having are suggestive of another diagnosis.

Reducing Your Risk

So do PPIs have an important place in managing acid reflux symptoms? Yes. Are they safe? Yes, when used appropriately. So don’t continue to blindly take these medications over the counter indefinitely. Talk to your doctor about your use and make sure to also include these preventative methods in your daily routine:

• Eat sparingly; when the stomach is full there is more reflux into esophagus

• Stop smoking; nicotine relaxes the lower esophageal sphincter, making it easier for food and acid to reflux into the esophagus

• Avoid certain foods—e.g spicy foods, garlic, alcohol can increase acid production. 

• Don’t drink carbonated beverages—these promote burping sending acid into the esophagus.

• Sit up after eating, don’t lay down right away—gravity keeps food and acid in the stomach.

• Lose weight, if appropriate—extra weight causes the muscular structure to change, loosening the closure at esophageal sphincter.

• Ask your doctor to review your medications—some can irritate your esophagus.

Is your acid reflux giving you the flux? Do you have some questions or want to make a comment? I’d love to hear from you. You can post them on Twitter or Facebook using #AskNurseAlice or email them to info@AskNurseAlice.com.

This technology could improve compliance rates of people taking their medications, improve the quality of life, and customize the way we deliver medication and allow medications to truly be delivered in doses most suitable for the patient. Currently, many pills come in a standardized dose, for example in 5, 10, and 20 mg of a said medication. With vapor jet printing there is an opportunity to customize the dose and perhaps give 7.5 or 12mg of that same medication if more appropriate based on the patient’s size and condition. There may be times when a smaller person doesn’t need as much medication as a larger person but because of how current medication is packaged there isn’t an opportunity to customize the dose. This technology also has implications for speeding up clinical trials and getting more effective medications to patients sooner as these medications are dissolved and absorbed differently than traditional pills.

When I spoke to Dr. Max Stein, lead researcher and an associate professor at the University of Michigan in the Department of Chemical Engineering and Materials Science, he mentioned that this technology is promising and even with the rigorous process of getting FDA approved, he’s optimistic that we could see the likes of this technology as soon as five years from now.

What do you think? Would you be interested in taking multiple medications in one dose? What questions do you have about printed meds? Post your comments and questions below and/or on social media including #AskNurseAlice and I’d be happy to answer them.

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