So here we are! The Grand Finale of the Acidity series!
In this post we'll be learning how two widely used anti-ulcerant (also anti-acid not antacid) medications work to suppress acid production in patients with severe Gastro-Oesophageal Reflux Disease that failed to respond to lifestyle modifications.
Now would be a good time to quickly read How our body produces acid if you haven't already.
In the image above, we see Ach, Gastrin and Histamine stimulating the production of acid from the parietal cells of the stomach. Out of these 3, currently we only have medications available in the market that prevents histamine from binding to it's receptors. But as you can do the math, anti-histamines will reduce acid production by only a third, because Ach and Gastrin will still keep stimulating acid production.
Proton Pump Inhibitors (PPIs)
Now these are very potent drugs to reduce acid production. These drugs basically grabs acid production by the throat and throttles it!
Remember from Episode 1 that all three of ACh, Gastrin and Histamine meets at a final common point, The Proton Pump. All three of these factors in the end has to increase the activity of the proton pump to increase acid production.
PPIs are on point! They inhibit this very important pump which is essential for all the three primary stimulators of acid production. And in doing so, PPIs inhibit acid production 3 times better that anti-histamines.
Not surprisingly thus, PPIs are the most widely used drug for GERD or acidity or heartburn, whatever you call it! Drugs like omeprazole, esomeprazole, lansoprazole, rabeprazole, etc. are all PPIs. My Bangladeshi readers will know these drugs by names such as Nexum, Maxpro, Seclo and so on.
While these are excellent in controlling acidity, it must be used in moderation. Unfortunately, most patients don't feel like they need to consult their doctors for such a simple matter as taking a PPI. What ends up happening is, patients who keep using PPIs continuously for 1 year, 2 years, 3 years, 5 years, 10 years, and so on! I'm not kidding!
Now you might think what's the harm! I'm just reducing acid which wasn't doing much other than just create irritating reflux symptoms of heartburn! Well, not quite!
There are 2 very important functions of this acid!
1. Iron Absorption
The iron we ingest in our food is in a state we can not absorb. It is in a state called the Ferric Iron, which is the oxidized form of iron. This form of iron is of no use to us. ACID in the stomach is absolutely necessary to reduce the oxidized form of Iron into the Ferrous Iron, the reduced for of Iron. Ferrous Iron is the state of iron that we can absorb.
You have all heard that iron is needed to make blood. Well, Red blood cells. To be more precise, Iron is essential to synthesize Haemoglobin, which is the oxygen carrying molecule in a Red Blood Cell.
So do the math now! If you have less acid, you have less iron. You have less iron, you have less hemoglobin and you develop what we in medical science call, Iron Deficiency Anemia.
Relax! You're not suddenly anemic because you have been taking PPIs for you acidity for the past 10 days. You don't need to run to the doctor and get your hemoglobin levels checked! Not yet, at least!
Our Liver is a wonderful, and massive organ! Besides it's uncountable functions, one it does very very well is store large amounts of Iron. (Yep, this is why you've heard eating chicken (or any other animal for that fact) liver increases hemoglobin levels/Iron levels/Creates more blood or similar things along these lines...you get the idea!)
In a study published in the GastroJournal (Link in references) it was concluded that continuous use of PPIs for at least 2 years is strongly associated with development of Iron Deficiency Anemia.
So you should never keep taking medications indefinitely and follow the dosage and duration as exactly what the doctor ordered.
2. Protection against Microbial Infection
We already know from episode 1, that the HCl produced is strong enough to finish off any microbes that reaches our stomach. But we're not gonna be talking about every single type of micro organism now, but we are going to talk about a very special bacteria. Helicobacter Pylori.
H.Pylori has been labelled as a _Class 1 Carcinogen_ by the world health organisation! And long term acid suppression significantly increases your risk for infection with this bacteria.
While the acid in the stomach is strong enough, H. Pylori has it's own arms and ammunition! It is well equipped to neutralize the acid due to the presence of an enzyme called Urease. Even then, the acid in our stomach is usually strong enough, which is why H. Pylori has to try and hide within the protective mucosal layers to survive. But now imagine, you've reduced the available acid and you have H. Pylori lurking around in your stomach! Oh boy they're gonna love this reduced acid and grow and multiply and cause gastric ulcers and will predispose to formation of gastric cancer if left untreated.
In fact the risk of developing gastric cancer from H. Pylori is so high _(9 times higher to be precise, according to a journal published in the NCBI [link in references]) that it is now recommended any patient who needs to take PPIs for more than a year, should undergo H. Pylori eradication therapy as that patient will be predisposed to an H. Pylori infection due to prolonged acid suppression!
So ask yourself, are you predisposing yourself to a potential carcinogen by taking Anti-Ulcerant medications indefinitely! I understand people might think it's just a simple medication. I don't need to consult a doctor for this! But when in fact you have no idea what you're getting yourself into because you didn't know.
Consult your physician before taking any medication!
Until next Time, Stay Healthy!
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Davidson Principles and Practice of Medicine, 23rd Edition
Harrison's Textbook of internal Medicine, 20th Edition
Proton Pump Inhibitor and Histamine-2 Receptor Antagonist Use and Iron Deficiency, Gastrojournal
Helicobacter pylori: a true carcinogen?
Helicobacter pylori in gastric carcinogenesis