Most of us will experience heartburn at some point. Heartburn occurs when stomach acid or food is thrown from the stomach into the esophagus, causing painful burning. If you only have heartburn from time to time, you can cure it or take an over-the-counter “antacid” drug that neutralizes stomach acid and prevents it from burning.
But if you often have heartburn, your doctor may recommend that you take a “proton pump inhibitor” or PPI. These are medications with brands like Nexium or Losec that reduce stomach acid to very low levels and can be very effective in combating the burning sensation in the chest. The trouble is that long-term use of PPIs can be harmful.
Concerns about their long-term use are that they may increase the risk of bone fractures, vitamin B and magnesium deficiency, as well as infection with Clostridium difficile bacteria, which can cause serious intestinal damage, and in some vulnerable people – to increase the risk of premature death.
To try to responsibly reduce the number of PPI drugs used in Australia, researchers have developed and evaluated an annual educational program focused on GPs to tell them about the possible risks of long-term use of PPIs. It was also brought to the public.
The researchers then looked at trends in PPI discharges between 2012 and 2018. Educational interventions were conducted in 2015 and 2016, and during that time, researchers noticed a slight decrease in PPI discharge – by about two percent. But many Australians have continued to use high-strength PPIs for years and have shown no signs of slowing down.
Getting people to cut down on drugs is a daunting task. Once you’ve started something and it seems to help, it gets hard to stop.
This study shows that educational initiatives seem to have limited effect, even when implemented on a large scale. If you have been using PPIs and have been taking them for a long time, it may be helpful to talk to your doctor about other medications that you might consider, whether you can reduce the strength of your drug or actually better perform surgery to solve the problem.
For reference: Bruno et al (2019). Passing an acid test? Assess the impact of national educational initiatives to reduce the use of proton pump inhibitors in Australia. Quality and safety BMJ doi: 10.1136 / bmjqs-2019-009897.