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Are you stuck on heartburn medications?

Taper off heartburn medications if you are willing to make lifestyle changes to prevent the problem from coming back.

To any man once tormented by frequent heartburn from stomach acid backing up, not taking your daily tablet of omeprazole (Prilosec) or lansoprazole (Prevacid) might seem like a bad idea. These and similar drugs, known as proton pump inhibitors (PPIs), are the foundation of treatment for chronic acidic heartburn, also known as gastroesophageal reflux disease (GERD).

But some men with GERD may be able to leave their heartburn pills behind. That means one less pill to take—two if you must take them twice a day. It also means lower costs and less of a chance of unwanted side effects. Once off the PPI, you could go back to taking antacids only when you need them.

“If the symptoms are gone and you are willing to make lifestyle changes, you could try to taper down on the medication,” says Dr. Jacqueline Wolf, a gastroenterologist and associate professor of medicine at Harvard-affiliated Beth Israel Deaconess Medical Center. “Lifestyle changes are important to keep the problem from coming back.”

It has to be done carefully. If you suddenly stop taking PPIs after being on them for a long time, your GERD could come galloping back with a vengeance.

Who can stop?

  • You can taper off PPIs if you have garden-variety GERD and no other complicating medical conditions. But your doctor may advise you to keep taking a PPI if either of these conditions applies:

  • You have a history of ulcers and need to take aspirin and other nonsteroidal anti-inflammatory drugs (NSAIDs). This includes men who take daily
    aspirin for heart protection and those who take NSAIDs for arthritis or
    other conditions.

You have been diagnosed with precancerous changes in the base of the eso-phagus, known as Barrett’s esophagus.

PPI snapshot

How do they work?

Proton pump inhibitors (PPIs) shut down the acid-producing “pumps” in the stomach. Taken before your first meal of the day, PPIs sharply reduce acid secretion and therefore the irritation it causes when stomach contents back up into the esophagus.

How do you get them?

These PPIs can be obtained over the counter in the United States: esomeprazole (Nexium), lansoprazole (Prevacid), omeprazole (Prilosec), and omeprazole plus
sodium bicarbonate (Zegerid).

These are available only by prescription: dexlansoprazole (Dexilant), pantoprazole (Protonix), and rabeprazole (Aciphex).

Image: Thinkstock

How to taper off

There is no universally recommended way to taper off PPIs. Dr. Wolf advises people taking the lowest dose of a PPI once a day to gradually replace the PPI with an acid-reducing drug in the class known as H2 blockers. These include cimetidine (Tagamet), ranitidine (Zantac), famotidine (Pepcid), and nizatidine (Axid).

You can replace one dose of the PPI with an H2 blocker each week for seven weeks. Or you could just start taking the H2 blocker every day for a week or two before stopping altogether. Ask your doctor for a recommendation.

If you take larger doses of a PPI or take it twice a day, it may be necessary to first lower the doses before replacing them with the H2 blocker. Again, ask your doctor for advice about this.

Lifestyle changes are key

Without changes in habits, you may end up right back where you started. According to a recent guideline issued by the American College of Gastroenterology (ACG), the following advice is supported by evidence:

  • Lose weight. Being overweight is the leading cause of GERD. (Eating large meals may also worsen GERD.)

  • For those with GERD at night, avoid eating two to three hours before your normal bedtime. Also, sleep with your upper body slightly above stomach level by elevating the head of the bed slightly on blocks or by using a wedge-shaped cushion. It reduces pressure on the opening between the upper stomach and base of the throat. Just propping up your head with pillows won’t work.

Many people find that certain foods cause heartburn, but the ACG does not recommend automatically and permanently avoiding chocolate, caffeine, alcohol, acidic foods, spicy foods, or fatty foods. But if you think certain foods trigger your heartburn, try cutting them out for a while to see if it makes a difference.

However, Dr. Wolf recommends completely avoiding foods with mint, since it may loosen the passageway from the stomach to the esophagus and allow acidic material to back up into the esophagus and throat.

Posted by: Dr.Health

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