Big feeds, booze... say hello to reflux

A friend told me it is bad for the body to keep taking acid reflux medication for years on end. Is this true? If so, why, and are there alternative cures or ways to alleviate the problem (apart from diet)?
- JM
Gastroesophageal reflux disease is a common, painful, and often chronic condition that in some people can lead to pre-cancerous lesions.
The most widely used medications for reflux are the proton-pump inhibitors, or PPIs, such as Losec (omeprazole). PPIs are very effective at reducing stomach acidity, allowing irritated stomachs to heal. But lower acidity also means greater risk of bacteria growing in your gut, leading to increased rates of bacterial pneumonia and colon infections for those on PPIs long term.
Studies have also linked long-term PPI use with hip fractures in the elderly, as well as problems with calcium and vitamin B12 absorption, not to mention rebounding reflux symptoms when PPIs are suddenly discontinued.
A reasonable path would be to use PPIs episodically, rather than continuously, and at the lowest effective doses. Consider rotating therapy to include other reflux treatments like H2-blockers and simple antacids.
And of course, do your best to reduce your chance of reflux in the first place: lose excess weight; don't eat or drink for three hours before bedtime; and avoid large meals, alcohol and tobacco use. Even simple things like raising the head of your bed a few inches can help.
And for those unlucky few who suffer severe disease resistant to treatment, surgical procedures such as gastric fundoplication offer quite high success rates, and can be done laparoscopically, meaning less pain and shorter recovery times.
Gary Payinda MD is an emergency medicine consultant in Whangarei.
Have a science, health topic or question you'd like addressed? Email: drpayinda@gmail.com
(This column provides general information and is not a substitute for the medical advice of your personal doctor.)