When Proton Pump Inhibitors Do More Harm Than Good

Q. Several years ago I started having severe chest pains that seemed to be stress related. I went to a cardiologist, who checked me out completely and said I didn’t have any heart problems. My regular doctor then said gastroesophageal reflux disease (GERD) was causing my chest pains and put me on Protonix (40 milligrams a day). When that didn’t help, he moved it up to 80 milligrams a day, but I still had the chest pains. 

About a year ago, I started having severe diarrhea. The doctor said I had developed irritable bowel syndrome and put me on Asacol (800 milligrams three times a day). I’ve been taking the drug for about a year now but still have horrible diarrhea. What’s more, I have so much stomach acid that it comes up into my mouth when I try to sleep lying down.

With all this going on I began losing weight. About six months ago, I was already down more than 40 pounds. My doctor said I was severely anemic and put me on ferrous sulfate, a multivitamin and a calcium supplement with vitamin D. Two days ago, I went back to my doctor because I’m still losing weight and he told me he wanted to start me on a new drug (Humira) for the irritable bowel syndrome. I looked it up, and the more I read the more alarmed I became, as some of the side effects can be fatal. I just keep going downhill. Could it be I’m on the wrong drugs?

A. I’m sorry that you’ve been through this ordeal. When I read your story, however, I think your problems are drug-related, which means you likely can regain your good health.

Let’s start with your first symptom: chest pain. If GERD, or heartburn, were the source of the pain, it would get worse when you eat or sleep, not only when you’re under stress. So pantoprazole (Protonix), one of a family of drugs for treating GERD known as proton pump inhibitors, is probably not the right therapy for your GI-related pain.

Moreover, the higher dose of 80 milligrams a day is totally outside of accepted treatment parameters (except for a relatively rare condition known as Zollinger-Ellison syndrome). The fact that stomach acid is sometimes coming up in your mouth suggests to me that the Protonix is causing what we call “rebound acid hypersecretion.” That’s where your stomach starts secreting ever-increasing amounts of acid to compensate for the drug’s action to slow it down.

The high dose of Protonix — not irritable bowel syndrome — is likely the cause of your diarrhea. One of the most serious side effects of proton pump inhibitors (PPI) is C. difficile diarrhea. I’ve seen this in many older patients, and the Food and Drug Administration recently issued a safety alert about these drugs and diarrhea that doesn’t go away. The PPI actually lowers the acidity of the stomach so much that the C. difficile bacteria — normally kept at bay by the acid in your stomach — proliferate out of control.