July 17, 2012

Breaking: AGA Survey Reveals Majority of PPI Users Still Have GERD

Street art, Williamsburg, Brooklyn 

An article published in the July issue of Gastroenterology and Endoscopy News reveals over half (55%) of PPI users in one study (1000+ people) still suffer from GERD symptoms.   The study, sponsored by the American Gastroenterological Association, states, " Of those taking a PPI, 55.3% reported that they continued to experience heartburn or other symptoms of GERD that significantly disrupted their life."  

Other doctors question the findings -- all of the people on PPIs may not have GERD.  The may be treated for GERD symptoms but PPIs are not helping because that's not the underlying cause:  "Lack of a symptomatic response to PPIs suggests either poor compliance with the correct dosing or timing of the medication [or] volume reflux, such as in those with regurgitation or non-GERD causes."

A quick search around the Internet demonstrates my own concerns about PPIs -- that, often, they are just an easy "fix" for GI doctors.   Medication is doled out as if that is the only option, and patients and doctors love the convenience --  the"science" -- of it.  Taking a pill or three is a lot easier than adjusting your eating pace and portion size, avoiding or reducing certain foods, and re-training yourself to be more mindful of how things affect your body.    My own GI doctor was quick to write out a slew of prescriptions (which I tried, but to no avail).

Look at this MedicineNet entry for GERD, in which the expert answers the question, "What is a reasonable approach to the management of GERD?":
If symptoms of GERD do not respond to maximum doses of PPI, there are two options for management. The first is to perform 24-hour pH testing to determine whether the PPI is ineffective or if a disease other than GERD is likely to be present. If the PPI is ineffective, a higher dose of PPI may be tried. The second option is to go ahead without 24 hour pH testing and to increase the dose of PPI. Another alternative is to add another drug to the PPI that works in a way that is different from the PPI, for example, a pro-motility drug or a foam barrier. If necessary, all three types of drugs can be used. If there is not a satisfactory response to this maximal treatment, 24 hour pH testing should be done.

Higher and higher.  And a Google search results in numerous threads from GERD sufferers agonizing about their continuing symptoms despite an arsenal of revolving meds.  Insanity!  [Disclaimer: I'm not a frequent medication taker -- I'll avoid all congestion medication, most painkillers, and don't get a flu shot.  So I'm coming into this discussion skeptical of PPIs…]

I'm not saying PPIs aren't valuable -- or critical -- for some people.   I know people who have had GERD resolved after short-term medication courses, and my mom is destined for long-term PPI-driven management due to a hernia complication.  This is just a reminder to "listen to your body," continue to ask your doctor questions, don't second-guess your gut, and STAY MINDFUL of the sometimes subtle things that work /don't work.


  1. I'm very excited about your blog! I've had stomach problems for three years now, at first I thought it was my gallbladder but they finally diagnosed me this past year with GERD. I'm taking 6 pills a day now and still having issues. The part that is most frustrating for me is I follow the diet rules as close as possible, which isnt even hard for me because I'm a vegetarian anyway and avoid caffeine. I don't want to have to take pills for the rest of my life, and my doctors have given up pursuing any other options now that I'm labeled. Anyway, point it, I'm so glad I found your blog, thank you for writing it.

  2. Hi roesmccoy -- thanks for the feedback! I know what you mean about medication-centric doctors. My doctor wanted to put me on more meds after two didn't work, noting the root of my GERD is probably stress. I decided to try to manage the stress, instead, and see if this helps. So far, I'm still a mess, but at least I'm learning all the subtle and not-so-subtle signals my body gives me about what it will tolerate (or not). This week, I'm omitting caffeinated tea since my esophagus has been especially clenched. Is there anything that has worked for you, to manage your GERD? Any foods you eat (or avoid), or actions that make you feel better?