Proton Pump Inhibitors
Proton pump inhibitors are medications that are given to patients who have gastro-oesophageal reflux disease (GORD) and stomach ulcers that reduce the amount of stomach acid that the body produces.
- Treat stomach ulcers and GORD.
- Work by reducing the amount of acid produced in the stomach.
- Side effects are usually mild when they occur.
If you have any concerns about gastro-oesophageal reflux disease or stomach ulcers, you can speak with one of our GMC-registered clinicians via our online video consultation service. They are available for appointments between 9.30am-4.30pm, Monday to Friday.
What are proton pump inhibitors?
Proton pump inhibitors are drugs that are prescribed to control the level of acid in the stomach. They are primarily used in the treatment of stomach ulcers and gastro-oesophageal reflux disease (GORD). In most cases, they are well tolerated, and are usually available in tablet, capsule or liquid form.
What are stomach ulcers?
Stomach ulcers are sores that develop in the stomach, and sometimes in the intestines just beyond the stomach, in an area called the duodenum. They may also be referred to as gastric or peptic ulcers. Stomach ulcers are a fairly common condition in the UK, although it’s difficult to determine exactly how many people have them as they do not always present with noticeable symptoms.
If you experience symptoms that include vomiting blood, dark sticky stools and a sudden, sharp pain, you should seek medical attention immediately.
Stomach ulcers can occur at any age, but are more common in people over the age of 60. Men are more likely to experience them than women.
What symptoms can stomach ulcers cause?
The most common symptom is a gnawing or burning sensation in the stomach that can spread to the neck and back. These attacks can last anywhere from a few minutes to several hours. It is usually triggered by eating and can get worse at night when lying down.
Other common symptoms include indigestion, nausea, vomiting, weight loss and heartburn. If you experience symptoms that include vomiting blood, dark sticky stools and a sudden, sharp pain, you should seek medical attention immediately.
What causes stomach ulcers?
The most common cause of stomach ulcers is the helicobacter pylori bacteria, an infection that affects the lining of the stomach. It doesn’t cause any issues in some cases, and does not always cause open sores to form.
Another common cause of stomach ulcers is the use of non-steroidal anti-inflammatory drugs (NSAIDs). These treatments are prescribed to treat various conditions that cause pain, fever or inflammation. Two of the most common forms of NSAIDs are aspirin and ibuprofen, and prescription treatments, such as naproxen, are also available.
While many people are able to use NSAIDs without them causing any issues, they can lead to stomach ulcers in some instances, particularly if they are taken in high doses. Lifestyle choices, such as consuming large amounts of alcohol, and stress, were once considered to be the primary causes of stomach ulcers, but there is no evidence to support this. These factors may exacerbate already existing factors, however.
How are stomach ulcers diagnosed?
Diagnosing a stomach ulcer usually consists of a test for the presence of helicobacter pylori bacteria in the body. This will likely require a urea breath test, where a special drink that is broken down by the bacteria is consumed in order to establish if an infection is present. Other tests include analysis of a stool sample and a blood test.
It is also possible that you will be sent for gastroscopy, which entails a very thin tube being passed through your mouth to the stomach and duodenum. A sedative and a mild anaesthetic is typically offered prior to the test so that you can remain comfortable.
How are stomach ulcers treated?
Treatment for stomach ulcers depends on the cause. In cases where someone has a helicobacter pylori infection, two types of antibiotics are usually prescribed for one week; typically, a combination of amoxycillin, metronidazole and clarithromycin. While the infection heals, a proton pump inhibitor may be prescribed to manage symptoms. After around four weeks, you will be retested to see if the infection has cleared up.
In cases where stomach ulcers have been caused by NSAIDs, a review of these medications is required, and other treatments, such as H2 receptor antagonists, may be considered. While the stomach heals, proton pump inhibitors can be used to help control symptoms. Other medications that can help to control symptoms include antacids, which are available over the counter. Antacids also control the production of acid in the stomach, while alginates help to provide the stomach with a protective lining. These over the counter options are effective for the immediate relief of stomach acid symptoms, and can be taken while you are waiting for proton pump inhibitors to take effect.
What is GORD?
GORD is caused by the presence of stomach acid outside of the stomach; particularly where acid travels upwards towards the throat. If it occurs only occasionally it’s referred to as heartburn, whereas if it happens constantly, it’s diagnosed as GORD. Symptoms include a burning sensation in the chest, a sour taste in the mouth, bad breath, a hoarse voice, coughing, hiccups, bloating and nausea. These symptoms tend to be worse after eating or when lying down.
What causes heartburn and GORD?
There are various causes of heartburn, and sometimes it’s hard to pinpoint why it occurs, but the most common triggers include eating spicy or fatty food, alcohol, coffee, obesity, smoking, anxiety, stress, being pregnant, medication and a condition called hiatus hernia, where a part of the stomach moves up into your chest.
Treatment to reduce the amount of acid that is produced in the stomach is one of the most common ways of dealing with GORD. Treatment usually consists of the use of proton pump inhibitors for a month or two, to see if your symptoms improve. If medication isn’t effective, then tests, such as a gastroscopy, may be considered. Your doctor may also suggest an operation called a laparoscopic fundoplication, that can help to stop acid reflux recurring.
If you would like to discuss proton pump inhibitors or any other related conditions with a registered clinician, our online video consultation service is available from 9.30am-4.30pm, five day a week. Our clinicians can also issue fit notes and referrals to specialists for treatment, where suitable.
What side effects can proton pump inhibitors cause?
All medications can cause side effects, and it’s important that you are aware of what these are for your specific treatment before use. You can discuss any potential side effects with your prescribing clinician, and you can also refer to the patient information leaflet that comes with your medication for more information.
Because there are a number of different proton pump inhibitors available, the information listed below may not be relevant for your specific treatment. The following side effects relate to the medication omeprazole.
You should stop using omeprazole and seek immediate medical attention if any of the following symptoms present:
Rare side effects (may affect up to 1 in 1,000 people): sudden wheezing, swelling of your lips, tongue and throat or body, rash, fainting or difficulties in swallowing. These may be signs of a severe allergic reaction.
Very rare side effects (may affect up to 1 in 10,000 people): reddening or peeling skin, blisters, yellow skin, dark urine, fatigue, breathing difficulties, dizziness, bleeding and bruising.
Omeprazole can also affect white blood cells leading to immune deficiency.
Other side effects include:
Common side effects (may affect up to 1 in 10 people): headaches, diarrhoea, stomach pain, constipation, flatulence, nausea, vomiting and stomach polyps.
Uncommon side effects (may affect up to 1 in 100 people): swelling of the feet and ankles, insomnia, dizziness, pins and needles, sleepiness, vertigo, altered blood test results relating to the liver, skin rashes, hives, itchy skin, feeling unwell, lack of energy and increased risk of fractures to the hip, wrist or spine.
Rare side effects (may affect up to 1 in 1,000 people): reduction in white blood cells or platelets, low levels of sodium in the blood, agitation, confusion, depression, changes in taste, blurred vision, wheeziness, shortness of breath, dry mouth, inflammation inside the mouth, hair loss, skin sensitivity to sunshine, joint pains, muscle pain, severe kidney problems, sweating, liver problems and thrush.
Very rare side effects (may affect up to 1 in 10,000 people): aggression, hallucinations, liver failure, inflammation in the brain, muscle weakness and enlarged breasts in men.
The following side effects have been reported but there is not enough data to determine their frequency: low levels of magnesium leading to fatigue, involuntary muscle contractions, disorientation, convulsions, dizziness, increased heart rate, a reduction in potassium or calcium levels, inflamed colon and watery diarrhoea.
Can proton pump inhibitors interact with other medications?
Because proton pump inhibitors can interact with other medications and cause negative side effects, it’s essential that you make your doctor aware of any other treatments you are currently or have recently taken. This includes over the counter treatments and supplements.
The following information relates to omeprazole, and may not apply to your specific treatment: do not use this treatment if you are taking nelfinavir (a HIV medication).
Your clinician may explore an alternative treatment option with you if you are taking any of the following: ketoconazole, itraconazole, posaconazole, voriconazole, digoxin, diazepam, phenytoin, warfarin, vitamin K blockers, rifampicin, atazanavir, tacrolimus, methotrexate, St John’s wort, cilostazol, saquinavir, clopidogrel, erltinib, clarithromycin, amoxicillin and clarithromycin.
Warnings and precautions when using proton pump inhibitors
If you have any health issues or conditions, you should tell your doctor before starting treatment.
In the case of omeprazole, you should inform your clinician about any of the following: unexplained weight loss, stomach pains, indigestion, vomiting, pass black stools, passing blood-stained faeces, severe or persistent diarrhoea, severe liver problems, skin reactions after treatment with proton pump inhibitors in the past, rashes when your skin is exposed to the sun, pain in your joints, problems absorbing vitamin b12 or you are due to have a Chromogranin A blood test.
Is it safe to use proton pump inhibitors if you are pregnant or breastfeeding?
Tell your doctor if you are pregnant, think you might be pregnant, are planning on becoming pregnant during treatment, or are breastfeeding. They can advise you on the safety of your specific treatment
What types of proton pump inhibitors are available?
There are a variety of types of proton pump inhibitors available, including tablets, gastro-resistant capsules and liquids.
The most common prescription proton pump inhibitors are omeprazole, lansoprazole and ranitidine.
Is it safe to drink alcohol whilst taking proton pump inhibitors?
Because alcohol can make symptoms worse, it should be avoided whilst taking proton pump inhibitors. If you are unsure, consult your clinician.
Can proton pump inhibitors affect your ability to drive?
While it’s unlikely that any side effects you experience from these medications will affect your ability to drive, it is possible for visual issues and dizziness to occur. You should therefore establish how this treatment affects you before operating any form of heavy machinery.
Can proton pump inhibitors cause allergic reactions?
You should inform your clinician about any allergies you have before starting treatment. For a list of the ingredients contained in your medication, you can refer to the patient information leaflet that comes with your treatment.
Some proton pump inhibitor tablets may contain lactose and certain capsules may contain sucrose, which some people can have an intolerance of.
Can I buy proton pump inhibitors over the counter?
It depends on the treatment and the form of the medication. For example, omeprazole is available to buy over the counter in tablet form, but not as a liquid. Consult your pharmacist or doctor for more information.
Can I buy proton pump inhibitors online?
You can discuss proton pump inhibitors with a GPhC-registered clinician using our online video consultation service. Our clinicians are available for appointments between 9.30am-4.30pm, Monday to Friday. They can also provide referrals to specialists for treatment and fit notes, where appropriate.