Gastroesophageal reflux disease (GERD) is estimated to affect 10-20% of the Western world and up to 30 million people in the United States alone.1 Increased stress may be a contributor to GERD symptoms, and clinical studies have suggested a relationship between GERD and anxiety, as well as depression,2 which may become an increasingly important clinical consideration during the COVID-19 pandemic.
The most popular GERD treatments, stomach acid reducers, are a booming business, with both H2 blockers and proton pump inhibitors (PPIs) used widely. Prescription PPIs are used by an estimated 15 million Americans.3 Taking an over-the-counter acid blocker for occasional heartburn symptoms may not be a big issue, but in practice, many patients with chronic reflux are prescribed acid blockers indefinitely. A significant number of researchers have independently linked PPIs to adverse health problems such as bone fractures,4 chronic kidney disease,5 and pneumonia,4 among others.
Given these risks, is there a better way to treat the increasingly common issue of GERD? In the following video, IFM educator Shilpa P. Saxena, MD, IFMCP, talks about the non-gastrointestinal symptoms of GERD, such as allergies, and identifies some of the steps she takes when developing a treatment plan.
PPIs: comparing the pros and cons
When establishing treatment for patients who require acid suppression, considering PPI benefits and risks associated with dosage amounts and duration is an important component.
Not all research suggests that PPIs are associated with adverse effects. For example, a three-year randomized trial of pantoprazole completed in 2019 did not find significant adverse events, with the exception of an increased risk of enteric infections.6 PPIs continue to be a primary therapy for acute and long-term management of GERD due to their:
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