“In the long term, it increases the risk of osteoporosis and therefore fractures.”
They are among the most prescribed treatments in France. These medications, capable of calming heartburn or reflux in a few days, have won over patients and doctors alike. Their rapid effectiveness and good short-term tolerance explain their success. However, behind their apparent harmlessness, their trivialization raises questions. They are sometimes prescribed unjustifiably, even as self-medication, without real medical monitoring even though their prolonged use is not without consequences, particularly among the elderly.
If they are overprescribed, it is also because they respond to disorders that have become extremely common, often linked to our lifestyle.. “A diet that is too fatty, too sweet, stress, excessive consumption of coffee or alcohol – all these factors promote gastroesophageal reflux. Added to this is the common use of nonsteroidal anti-inflammatory drugs such as aspirin or ibuprofen, known to weaken the stomach lining and promote ulcers,” explains Arnaud Cinturel, pharmacist. Faced with these multiple causes, these medications appear to be a simple, quick and effective solution, well tolerated in the short term – hence their massive use.
These drugs, which are more dangerous than you might think, are “proton pump inhibitors” or PPIs. Their role: to greatly reduce the production of gastric acid, by blocking the enzymes responsible for this secretion in the stomach. The oldest and best known of all is omeprazole. It is followed by pantoprazole, esomeprazole or even lansoprazole. “Used occasionally, they are safe. But in the long term, they can lead to nutritional deficiencies, persistent digestive disorders, and sometimes more serious complications, particularly in the elderly.” warns our expert. In seniors, these medications can disrupt the absorption of certain essential nutrients, such as calcium, magnesium or vitamin B12. “In the long term, this increases the risk of osteoporosis and therefore fractures. By modifying the pH of the stomach, PPIs also disrupt the balance of the digestive microbiota, which can promote the proliferation of undesirable bacteria, leading to an increased risk of diarrhea or, more rarely, kidney damage,” adds the pharmacist. PPIs can also reduce the effectiveness of blood thinners.
Social Security is starting to closely monitor the prescription of PPIs. “Even if these drugs are not very expensive per unit, their massive prescription represents a significant expense for the community. Discussions are underway around the supervision of their long-term use, in particular to avoid unjustified prolonged treatments. But the question remains delicate: doctors retain their freedom to prescribe, as long as they consider that it is medically justified”concludes Arnaud Cinturel.
Thanks to Arnaud Cinturel, pharmacist in Isneauville (Seine-Maritime), creator of the LePharmaPreneur YouTube channel.
