hey guys welcome back to my channel

today I'm gonna be talking about peepee

eyes or proton pump inhibitors which are

acid reflux they're not just for acid

reflux but that's what's in the

thumbnail there are basically

medications that reduce the amount of

acid that's being made by her stomach

but they're used in other purposes which

I'll get into as well there's been a lot

of controversy and a lot of scary things

on the internet that people have been

reading about and I get asked about this

in clinic all the time even though this

isn't really my main area but as a

gastroenterologist inevitably I'm gonna

be asked about some of these gpi's so

let's talk about this what's getting to

it so I'll be talking about what these

PPOs are how they work whether one is

better than the other and all the

controversies about whether or not they

could be harmful so I'll get to all of

that eventually so just keep watching

and we'll get there so before we get

started please don't forget to subscribe

by clicking on the red subscribe button

below first and foremost let's talk

about what our PPI is these are

medications that first came out in the

80s in the late eighties but they're not

just used to treat acid reflux they're

also used to treat ulcer disease they're

used to treat as part of the regimen to

treat the bacteria h pylori that can

live in your stomach and cause ulcers

and cause gastric cancer and it's also

used for inflammation of the esophagus

from reflux and for some people even

prevent long-term development of

esophageal cancer if they have chronic

changes from too much acid reflux

there's even a syndrome out there where

too much of the hormone gastrin is

stimulating the stomach to make acid so

this medication is definitely necessary

for conditions like that we also use

this medication when patients show up

bleeding from their stomach or if we're

suspecting bleeding from their stomach

or their esophagus

we will put them on epi medication in an

IV form so it's used to treat GI

bleeding as well there are multiple

different brands and a lot of these

brands are actually over-the-counter

which is what this thumbnail shows

target and I grabbed a bunch of these

and they were all from different brands

and it just goes to show how there are

so many different brands and this is not

an endorsement of any specific brand we

just use all of them there is some

variation for the different types of

proton pump inhibitor medications as to

what you can use them for but in general

they all work the same way employing

some sort of similar mechanism so that's

why they fall into the same category and

all end in the same suffix so if you

look at the generic name not the brand

name the generic name all end with pres

old PRA co-led whether it's omeprazole

and tilt this off Ethernet Bazaar

there's other ones that I'm probably

leaving out but they all end with puzzle

one key thing to keep in mind right off

the bat is that these medications are

different from histamine blockers h2

blockers that you might hear your doctor

saying these are medications like pep

said or zantac which are in a different

category of medication to act a

different way altogether PPIs are also

different from tums and Rolaids and

other sorts of antacids that purely

serve to sort of neutralize the stomach

acid rather than reduce the actual

production of acid buyer Stein so that

brings us to how do these PB eyes work

so really the medications contrary to

popular opinion are actually absorbed in

your small intestine once it's absorbed

into your intestine through the

bloodstream that will make its way to

the cells of the lining of your stomach

and block off that part of the cell that

travels to the surface of the cell to

actually push the acid out so you need

to take this medication about half an

hour before you eat and you definitely

have to be because when you eat that's

when your cell actually signal to

secrete acid so that's when the

medication can actually work so the PPI

is work longer than

two blockers for the end absence so the

effect intends to be maintained over

time and the general thought is that

these are the most effective because

this is really blocked off that very

last step of all the pathways when it

comes to actual secreting of the acid so

now comes the question is any brand any

better than the other and the answer is

probably not there been so many studies

studying this there's no really great

consensus some studies sort of save it

there was a fun that's better the other

but dosing is off if you look at the

study also the different studies out

there are for different conditions some

of them are for acid reflux some of them

are for ulcers so it's really hard to

compare just like anything else things

that actually get published tend to be

positive studies that show that things

work the things that show that things

don't work don't usually get published

so we don't really know whether there

are negative studies that aren't being

published and in case you're wondering

this is called publication bias

now finally problems with proton pump

connectors so they've been reports out

there about proton pump inhibitors

causing c-diff related diarrhea causing

dementia causing kidney disease causing

osteoporosis and bone fractures of

magnesium and b12 deficiency causing

pneumonia so I would say that the

general consensus among the professional

gie community is that yes long-term use

of epi they increase your risk of

developing fetus related diarrhea or

osteoporosis I don't think that there's

any way that he wants to say that they

can't happen 100% but they might

increase your risk for some of these

conditions certain conditions that have

gotten a lot of media attention like

dementia can he

some of those studies are still very

controversial and kind of faulty your

drawing associations rather than

actually establishing a caucus like like

the PPI cause the disease we don't know

that just because you sample the

population that would pick out the

people who took DPI's versus those who

didn't and found that there were higher

rates of dementia that there was an

actual mechanism to explain them so I

think it's kind of part that's justified

know how PPI is potentially cause

dementia or how PPI

potentially cause kidney disease that

simply needs more science when we think

about feedeth diarrhea

maybe PPI it's altering the acid and

your stomach might be affecting your gut

microbiome or the fact that we can't

absorb certain nutrients to maintain

bone health over time it's also impacted

by how much acid your stomach makes some

of those explanations have scientific

basis whereas others are just vague and

we're still gonna figure it out so again

there is a lot of debate about this some

of these studies may not have been

accurate some of these studies might not

actually show their explanation for why

things are happening the bottom line is

you have to weigh the risks versus the

benefit weigh the risks versus the

benefit so some people would really edit


these medications if you have a ulcer

that's not healing or if you have those

chronic changes in your esophagus that

are precancerous you probably would

benefit from being on a PPI long term

and really reducing the risk of serious

complications or a cancer from happening

then something that is sort of not yet

well-established but in other conditions

for short term use yes I think getting

off of the medication and weaning off of

it is a great idea but the bottom line

is speak to your doctor because you may

or may not know whether or not you

benefit from long term use everyone

situation varies just speak to your

doctor they'll give you a better

assessment of whether or not this is the

right thing for you and maybe don't

discover that you don't need to be on it

and they'll take you off with the VPI so

in other situations it might actually be

necessary so don't just go ahead and

stop your PPI without asking your doctor

first so that's it for today thank you

for joining me if you like this video

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Dee and check out my website awesome

Shane calm until next time please stay

healthy I'll see you in my next video

bye guys