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How Proton Pumps Work
The proton pump is a molecule found in some cells of the stomach (parietal cells). Acting as a molecular machine, the proton pump takes a non-acidic potassium ion out of the stomach and replaces it with an acidic hydrogen ion. By putting hydrogen ions into your stomach, the proton pump increases the acidity of your stomach contents. Stomach acid is necessary to help break down food and aid digestion.
Too much acid, though, can irritate the esophagus, causing indigestion or heartburn, and it can slow the healing of stomach ulcers. When excess acid becomes problematic, proton pump inhibitor drugs are often prescribed to shut down the proton pump.
Why Some People With Arthritis Are Prescribed PPIs
To lower the risk of gastrointestinal complications, people with arthritis may be advised to take aCOX-2 inhibitor(e.g., Celebrex), or a traditional NSAID (e.g., naproxen, ibuprofen) with misoprostol or a proton pump inhibitor.Misoprostol has to be taken multiple times a day, can cause diarrhea, and may cause miscarriages, premature labor, or birth defects—so, PPI drugs are typically preferred.There’s alsoVimovo, a drug which combines an NSAID (naproxen) and a PPI (esomeprazole) in one pill.
The combination of a PPI drug with an NSAID is not necessary in all cases. PPI drugs have actually become overused. PPI drugs, heavily advertised and promoted to both consumers and healthcare providers, have been used to treat mild stomach upset or heartburn when over-the-counter remedies, including antacids (Maalox, Mylanta, TUMS) or H2 blockers (Tagamet or Pepcid), would be sufficient.
There are conservative guidelines that help manage NSAID toxicity:
Availability
Safety Concerns
Aside from common side effects (headache, diarrhea), there have been certain safety concerns associated with PPI drugs, such as:
Bottom Line
No differently than for any other drug, the benefits and risks of PPIs must be weighed in each individual case. Some people may not require PPI drugs to manage mild to moderate heartburn or GERD, even though they have been prescribed the drugs. Don’t stop the drugs without discussing it with your healthcare provider first. Stopping suddenly may actually increase symptoms.
People with arthritis may be able to decrease the risk of gastrointestinal toxicity associated with NSAID use without taking PPI drugs. Remember, even if PPI drugs are warranted for your specific condition, safe use implies only taking the drug for as long as it is necessary.
11 SourcesVerywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.Kinoshita Y, Ishimura N, Ishihara S.Advantages and disadvantages of long-term proton pump inhibitor use.J Neurogastroenterol Motil. 2018 Apr;24(2):182-196. doi:10.5056/jnm18001Herszényi L, Bakucz T, Barabás L, Tulassay Z.Pharmacological approach to gastric acid suppression: past, present, and future.Dig Dis. 2020;38(2):104-111. doi:10.1159/000505204Elias P, Castell D.The role of acid suppression in Barrett’s esophagus.The American Journal of Medicine. 2017 May;130(5):525-529. doi:10.1016/j.amjmed.2016.12.032Sostres C, Gargallo C, Lanas A.Nonsteroidal anti-inflammatory drugs and upper and lower gastrointestinal mucosal damage.Arthritis Res Ther. 2013 Jul;15(3):1-8. doi:10.1186/ar4175Maseda D, Ricciotti E.NSAID–gut microbiota interactions.Front Pharmacol. 2020 Aug;11(1):1-13. doi:10.3389/fphar.2020.01153Shroukh W, Steinke D, Willis S.Risk management of teratogenic medicines: a systematic review.Birth Defects Research. 2020 Sep;112(20):1755-1786. doi:10.1002/bdr2.1799Heidelbaugh J, Kim A, Chang R, Walker P.Overutilization of proton-pump inhibitors: what the clinician needs to know.Therap Adv Gastroenterol. 2012 Jul;5(4):219-232. doi:10.1177/1756283X12437358Lund L, Reilev M, Hallas J, et al.Association of nonsteroidal anti-inflammatory drug use and adverse outcomes among patients hospitalized with influenza.JAMA Netw Open.2020 Jul;3(7):1-11. doi:10.1001/jamanetworkopen.2020.13880Consumer Reports.Using the proton pump inhibitors to treat heartburn and stomach acid reflux.Jaynes M, Kumar A.The risks of long-term use of proton pump inhibitors: a critical review.Ther Adv Drug Saf. 2018 Nov;10(1):1-10. doi:10.1177/2042098618809927Helgadottir H, Bjornsson ES.Problems associated with deprescribing of proton pump inhibitors.Int J Mol Sci. 2019 Nov;20(21):5469. doi:10.3390/ijms20215469
11 Sources
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.Kinoshita Y, Ishimura N, Ishihara S.Advantages and disadvantages of long-term proton pump inhibitor use.J Neurogastroenterol Motil. 2018 Apr;24(2):182-196. doi:10.5056/jnm18001Herszényi L, Bakucz T, Barabás L, Tulassay Z.Pharmacological approach to gastric acid suppression: past, present, and future.Dig Dis. 2020;38(2):104-111. doi:10.1159/000505204Elias P, Castell D.The role of acid suppression in Barrett’s esophagus.The American Journal of Medicine. 2017 May;130(5):525-529. doi:10.1016/j.amjmed.2016.12.032Sostres C, Gargallo C, Lanas A.Nonsteroidal anti-inflammatory drugs and upper and lower gastrointestinal mucosal damage.Arthritis Res Ther. 2013 Jul;15(3):1-8. doi:10.1186/ar4175Maseda D, Ricciotti E.NSAID–gut microbiota interactions.Front Pharmacol. 2020 Aug;11(1):1-13. doi:10.3389/fphar.2020.01153Shroukh W, Steinke D, Willis S.Risk management of teratogenic medicines: a systematic review.Birth Defects Research. 2020 Sep;112(20):1755-1786. doi:10.1002/bdr2.1799Heidelbaugh J, Kim A, Chang R, Walker P.Overutilization of proton-pump inhibitors: what the clinician needs to know.Therap Adv Gastroenterol. 2012 Jul;5(4):219-232. doi:10.1177/1756283X12437358Lund L, Reilev M, Hallas J, et al.Association of nonsteroidal anti-inflammatory drug use and adverse outcomes among patients hospitalized with influenza.JAMA Netw Open.2020 Jul;3(7):1-11. doi:10.1001/jamanetworkopen.2020.13880Consumer Reports.Using the proton pump inhibitors to treat heartburn and stomach acid reflux.Jaynes M, Kumar A.The risks of long-term use of proton pump inhibitors: a critical review.Ther Adv Drug Saf. 2018 Nov;10(1):1-10. doi:10.1177/2042098618809927Helgadottir H, Bjornsson ES.Problems associated with deprescribing of proton pump inhibitors.Int J Mol Sci. 2019 Nov;20(21):5469. doi:10.3390/ijms20215469
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
Kinoshita Y, Ishimura N, Ishihara S.Advantages and disadvantages of long-term proton pump inhibitor use.J Neurogastroenterol Motil. 2018 Apr;24(2):182-196. doi:10.5056/jnm18001Herszényi L, Bakucz T, Barabás L, Tulassay Z.Pharmacological approach to gastric acid suppression: past, present, and future.Dig Dis. 2020;38(2):104-111. doi:10.1159/000505204Elias P, Castell D.The role of acid suppression in Barrett’s esophagus.The American Journal of Medicine. 2017 May;130(5):525-529. doi:10.1016/j.amjmed.2016.12.032Sostres C, Gargallo C, Lanas A.Nonsteroidal anti-inflammatory drugs and upper and lower gastrointestinal mucosal damage.Arthritis Res Ther. 2013 Jul;15(3):1-8. doi:10.1186/ar4175Maseda D, Ricciotti E.NSAID–gut microbiota interactions.Front Pharmacol. 2020 Aug;11(1):1-13. doi:10.3389/fphar.2020.01153Shroukh W, Steinke D, Willis S.Risk management of teratogenic medicines: a systematic review.Birth Defects Research. 2020 Sep;112(20):1755-1786. doi:10.1002/bdr2.1799Heidelbaugh J, Kim A, Chang R, Walker P.Overutilization of proton-pump inhibitors: what the clinician needs to know.Therap Adv Gastroenterol. 2012 Jul;5(4):219-232. doi:10.1177/1756283X12437358Lund L, Reilev M, Hallas J, et al.Association of nonsteroidal anti-inflammatory drug use and adverse outcomes among patients hospitalized with influenza.JAMA Netw Open.2020 Jul;3(7):1-11. doi:10.1001/jamanetworkopen.2020.13880Consumer Reports.Using the proton pump inhibitors to treat heartburn and stomach acid reflux.Jaynes M, Kumar A.The risks of long-term use of proton pump inhibitors: a critical review.Ther Adv Drug Saf. 2018 Nov;10(1):1-10. doi:10.1177/2042098618809927Helgadottir H, Bjornsson ES.Problems associated with deprescribing of proton pump inhibitors.Int J Mol Sci. 2019 Nov;20(21):5469. doi:10.3390/ijms20215469
Kinoshita Y, Ishimura N, Ishihara S.Advantages and disadvantages of long-term proton pump inhibitor use.J Neurogastroenterol Motil. 2018 Apr;24(2):182-196. doi:10.5056/jnm18001
Herszényi L, Bakucz T, Barabás L, Tulassay Z.Pharmacological approach to gastric acid suppression: past, present, and future.Dig Dis. 2020;38(2):104-111. doi:10.1159/000505204
Elias P, Castell D.The role of acid suppression in Barrett’s esophagus.The American Journal of Medicine. 2017 May;130(5):525-529. doi:10.1016/j.amjmed.2016.12.032
Sostres C, Gargallo C, Lanas A.Nonsteroidal anti-inflammatory drugs and upper and lower gastrointestinal mucosal damage.Arthritis Res Ther. 2013 Jul;15(3):1-8. doi:10.1186/ar4175
Maseda D, Ricciotti E.NSAID–gut microbiota interactions.Front Pharmacol. 2020 Aug;11(1):1-13. doi:10.3389/fphar.2020.01153
Shroukh W, Steinke D, Willis S.Risk management of teratogenic medicines: a systematic review.Birth Defects Research. 2020 Sep;112(20):1755-1786. doi:10.1002/bdr2.1799
Heidelbaugh J, Kim A, Chang R, Walker P.Overutilization of proton-pump inhibitors: what the clinician needs to know.Therap Adv Gastroenterol. 2012 Jul;5(4):219-232. doi:10.1177/1756283X12437358
Lund L, Reilev M, Hallas J, et al.Association of nonsteroidal anti-inflammatory drug use and adverse outcomes among patients hospitalized with influenza.JAMA Netw Open.2020 Jul;3(7):1-11. doi:10.1001/jamanetworkopen.2020.13880
Consumer Reports.Using the proton pump inhibitors to treat heartburn and stomach acid reflux.
Jaynes M, Kumar A.The risks of long-term use of proton pump inhibitors: a critical review.Ther Adv Drug Saf. 2018 Nov;10(1):1-10. doi:10.1177/2042098618809927
Helgadottir H, Bjornsson ES.Problems associated with deprescribing of proton pump inhibitors.Int J Mol Sci. 2019 Nov;20(21):5469. doi:10.3390/ijms20215469
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