Question: I have been experiencing indigestion and some acid reflux problems at night. My doctor has prescribed Omeprazole (20mg daily), which is working fine. It is a proton pump inhibitor (PPI) as are many others in this category. The medication information says that it works by blocking acid production in the stomach. How is the food digested if acid is blocked in the stomach? I have also heard that one should not stay on this type medication for extended periods of time. Is this correct?

Dr. Hibberd's Answer:

Your question is excellent. Acid in the stomach assists with breakdown of ingested food, and blocking acid secretion does indeed interfere with the digestive process, though the effective result of this is not usually recognizable to most patients.

Proton pump inhibitors (PPI's) are potent suppressors of acid secretion, and have made treatment of peptic ulcers much easier. We now rarely see the huge gastric bleeding we used to see before the advent of these agents. Initially, there were concerns that PPI's could possibly be harmful if used for the long term, but there appear to be no ill effects for most patients under the supervision of their physician.

The initial concerns that PPI's would stimulate chronically elevated gastrin levels and predispose patients to gastrinomas (a tumor of specialized gastrin-producing cells of the stomach), have not been confirmed in usual clinical use.

I do not recommend long-term unsupervised use of PPI's because of my concern that patients may treat their "indigestion" without searching for causes. This caution, required by the FDA, is printed on the side of the over the counter Prilosec preparations for your own safety. Some of the causes of indigestion include cardiac disease, Helicobacter Pylori (a bacterium associated with ulcer formation in the stomach that is treated with antibiotics), and drug side-effects. Other conditions include ulcer disease and undiagnosed malignancy. Supervision for long term use is always advisable for most if not all patients who are being treated for indigestion. The PPI's themselves appear to be very safe medications when used properly.