I've had acid reflux and have been taking Prilosec 20mg once a day for the last three years. Will Prilosec harm my liver over a long period?

Pam

Acid reflux, also known as GERD (gastroesophageal reflux disease), is a very common ailment in this country. Among the medications used to relieve GERD symptoms, as well as suppress stomach acid and lead to healing of esophageal inflammation, are the proton-pump inhibitors (PPIs).

The most familiar PPIs are omeprazole (Prilosec) and lansoprazole (Prevacid). Also, a new PPI called rabeprazole (Aciphex) was recently released. All these medications are potent inhibitors of gastric-acid production and are extremely effective therapies both for active GERD and for maintaining symptom relief after initial healing. Many people with severe GERD -- especially those with daily reflux, with significant esophageal inflammation or ulceration, or with stricture formation in the esophagus -- will need chronic, suppressive medication even after healing occurs.

PPIs are the best drugs to prevent symptom recurrence and further esophageal damage in GERD. Although the data are limited because PPIs have only been available for about 15 years, so far, there are no known severe long-term side effects of PPIs. Also, to answer your specific question, liver disease is not a recognized complication of Prilosec or other PPIs.

However, questions have been raised regarding the safety of long-term acid suppression for a variety of reasons: First, acid is important in the digestion of food. Thus, a lack of acid may theoretically lead to malabsorption of nutrients and malnutrition. Secondly, there is an association (although rare) with loss of acid production and the development of gastric cancer in patients with a stomach disorder known as atrophic gastritis. The worry is that if PPIs can suppress acid and lead to atrophic gastritis, then cancers could develop. Third, a lack of acid is also associated to result in tumors known as carcinoids, which secrete a hormone known as gastrin. Carcinoids were found in rats given large doses of PPIs in pre-marketing studies.

It's important to stress that all of the above concerns are theoretical and none have been borne out in clinical studies to date. So, the current recommendations are to give PPIs for an indefinite time if they are needed.

That said, one option for patients who have GERD requiring long-term PPI therapy is a surgical procedure known as fundoplication. This is an issue to discuss with your gastroenterologist.