An old problem

Forgacs and Loganayagam described the problem of overprescribing proton pump inhibitors (PPIs).¹ In June 2002 we wrote to many journals—and were ignored—about long term side effects being identified in general practice and surgery patients, with the then extensive, long term use of PPIs. At the time we shared an increasing number of patients with dependence on PPIs who experienced acute, severe gastritis and gastro-oesophageal reflux if they suddenly stopped or missed their PPIs; some showed refractory gastroparesis and severely delayed jejuno-ileal and colonic peristalsis when trying to reduce or stop their treatment after taking the PPI for extended periods (>3-60 months).

PPIs block the normal homoeostasis of the gastro-jejuno-ileal-colonic function (owing to their very specific, acid production blocking only, cellular-molecular actions:they block only the cellular or molecular acid production and allow secondary build up or excessive reduction of the hormones gastrin, cholecystokinin, secretin, glucagon, motilin, VIP, substance P, somatostatin, and other biologically active polypeptides, which changes all the homoeostasis processes of the whole gastrointestinal system); this allows the multiple secondary interdependent hormonal levels to rise or drop out of control and thus the parietal cells massively increase their cell surface membrane folds (7-14 times), until they appear fan-like on the gastric surface, increasing their ability to produce sudden large quantities of acid when the PPI stops. This results in a Zollinger-Ellison-like syndrome, and the patients restart their PPIs or even increase the dose, compounding the situation. We have been unable to identify any similar reports in the current medical literature, and we were concerned that independent gastroenterologists were aware of the indicated effects but had not considered them to be a problem.

Medical practitioners should consider reducing PPI medications in very gradual steps and question pharmaceutical companies’ pursuit of ever more lucrative drugs that do more harm, parallel to their good, to the human body when basic homoeostatic systems are forgotten or ignored.