I have GERD and have been on Prevacid 30mg per day for three years (Prilosec didn't work). I have tried several times to go off the medicine, only to have severe symptoms return by afternoon. Are there any documented side effects from long-term use of Prevacid?

G.

GERD (gastroesophageal reflux disease) is a very common condition in which the esophagus becomes damaged and inflamed due to reflux of stomach acid. Most people with GERD have mild disease with only occasional symptoms, often after large meals. They may improve after taking over-the-counter antacids or acid-blocking medications, such as ranitidine (Zantac) or cimetidine (Tagamet). Many of these people don't experience enough discomfort to even see a doctor.

On the other end of the spectrum, a small percentage of patients (such as you) suffer from frequent reflux, usually occurring multiple times per day. They often develop symptoms at night and may have complications of the reflux, such as cough, hoarseness, asthma and ulcers or scarring in the esophagus. In this group, daily medications such as the potent acid blockers of the proton-pump inhibitor (PPI) class are given, often twice a day on a regular basis. These include omeprazole (Prilosec) and lansoprazole (Prevacid).

In patients with severe GERD, treatment with PPI drugs is extremely effective, with success rates of 90 percent in many clinical research trials. Symptoms often disappear quickly after these medications are started. However, one must keep in mind that the cause of the GERD -- the failure of the sphincter separating the esophagus from the stomach -- is a chronic problem that is not modified by medications. This explains why most people with severe GERD develop recurrent symptoms when they discontinue PPI therapy. Many patients who required twice-a-day doses of Prilosec or Prevacid to get their GERD under control will be able to cut the dose to once a day, but more than half will relapse if they stop the medication completely.

PPI drugs have now been available for about 10 years and have been used even longer in clinical research studies. To date, no severe long-term side effects have been detected. One concern relates to a theoretical risk of atrophy of the stomach lining because of the long-term suppression of acid secretion by stomach cells, but this has not led to complications in patients so far. Thus, it is considered safe to take PPI medications indefinitely at this time.

One option for people with GERD who don't want to be on long-term medication is surgery. This procedure, known as fundoplication, involves wrapping the upper stomach around the lower esophagus to strengthen the sphincter and reduce reflux. It is extremely successful in improving symptoms and reducing medication requirements. There are potential side effects with this surgery, though, and you should be sure to ask your surgeon about them if you are considering the procedure.