‘Red flag’ omeprazole issue raised by NHS GP for acid reflux patients

BBC Morning Live’s Dr Punam Krishan provided crucial advice for anyone taking proton pump inhibitors (PPIs), such as omeprazole, for ailments including heartburn, acid reflux, and indigestion. Across the UK, one in four adults experiences acid reflux, with numerous people encountering it at various points in their lives, especially after consuming large meals.

People who suffer from it frequently may receive prescriptions for PPIs like omeprazole to assist in controlling symptoms. Dr Punam explained that those taking the medication must proceed with care, particularly if they’re taking it for an extended period, and stressed the importance of regular medical check-ups.

Dr Punam serves as an NHS GP and is the resident doctor on BBC‘s Morning Live. She also works as a media medic, health broadcaster, and writes children’s books, reports the Mirror.

Speaking to BBC Morning Live presenters, Gethin Jones and Helen Skelton, during an earlier episode of the programme, the medical expert started by clarifying what acid reflux involves. She said: “Acid reflux is all about what happens in your stomach. So we all have acid in our stomach and it has a very important role. The role of that is to break down and digest the food. Now, at the top of the stomach, we have a little valve, a sphincter, and it acts like a trapdoor.

“And its job is to basically seal the contents so the acid is not essentially tracking back up the food pipe, your oesophagus. However, if that sphincter, that valve, becomes too loose, it can become very relaxed by things like heavy meals. If you’ve had alcohol, if you lie down straight after having a heavy meal, that can actually mean that that acid from the stomach can end up creeping back up the food pipe and cause that heavy pressured burning sensation that people get.”

Presenter Gethin asked: “What about the most common ways to treat it then?” Dr Punam responded: “So there are lots of different things that we can do. If, of course, you’re having it just every now and then, then lots of people do get antacids or basically medications like alginates. Examples of that include Gaviscon. And these basically help to just kind of neutralise the acid. They’re very effective and you can just use them as and when needed.”

“However, if the discomfort is persistent, we often prescribe proton pump inhibitors, PPIs for short. Examples of these are omeprazole, lansoprazole. And these are incredible and have really transformed the way that we treat acid reflux. They essentially help to treat the acid production at the source.”

Issuing a word of caution to anyone taking PPIs, the NHS GP said: “Essentially these medications aren’t there to be used unnecessarily or for a long period of time. They do require us to review them. And that’s because if used over a long period of time, they can slightly increase your risk of things like low magnesium, low vitamin B12, but also increase the risk of gut infections, particularly Clostridioides difficile. We call that C. diff for short.”

She emphasised the importance of regular check-ups for those taking PPIs over a prolonged period. Dr Punam continued: “Now, we have this bacteria in our bowel, you and I, we all have it, and it lives in balance. However, medications like PPIs can tip that balance.” Highlighting a ‘red flag’ symptom to watch out for, she added: “And if you get overgrowth of this bacterium, it can cause persistent diarrhoea. That is a red flag.

“So you do need to speak to your doctor if that is an issue and you suddenly start developing diarrhoea. Or if you’ve got a change in bowel habit, we always say check in with your doctor. Just make sure that you are getting those reviews with your GP.”

Helen said: “I guess the trouble is if it works, you stick with it, don’t you?” Dr Punam replied: “Yeah, it is.” Gethin said: “But you don’t even know how long you’re taking it for in the end, are you?” Dr Punam told him: “Well, that’s just it. Sometimes you can just be taking it, and the problem is resolved, but you’re just taking the medication. So do go in for your regular reviews.”

How frequently should people taking PPIs visit their GP?

If you are taking omeprazole without a prescription, do not take it for longer than two weeks. You should consult a doctor if:

• Your symptoms do not improve after 14 days.
• Your symptoms worsen.
• Your symptoms return sooner than four months after finishing treatment.
• You experience alarming symptoms like difficulty swallowing, bloody vomit, or black stools.

Should your GP have prescribed omeprazole for long-term use, they should monitor you closely on a regular basis. Your doctor should draw up a schedule for follow-up appointments tailored to your individual health requirements and risk factors, for instance, every six to 12 months. If your GP recommends omeprazole for over a year, it is absolutely vital to attend routine check-ups to reduce the likelihood of experiencing long-term side effects.

What warning signs should you be watching for?

Signs of low magnesium include muscle cramps, fatigue, and an irregular heartbeat, along with less obvious symptoms such as loss of appetite, nausea, and general weakness. More severe deficiencies can lead to numbness, tingling, personality changes, seizures, and abnormal heart rhythms. Signs of low vitamin B12 include tiredness, weakness, pale skin, and a sore or swollen red tongue. Additional symptoms can encompass neurological problems such as pins and needles, difficulty with balance, and memory issues, alongside shortness of breath, heart palpitations, and digestive troubles.

Symptoms of a C. diff gut infection include watery diarrhoea, stomach cramps and pain, a high temperature (fever), nausea, loss of appetite, and dehydration. In severe cases, potentially life-threatening complications can emerge, such as serious inflammation of the intestines.

What tests are available to check for these conditions?

Helen questioned: “What if you want to do something without medication? Can you ease the symptoms without taking any meds?” The NHS GP responded: “So if you have got symptoms that have not settled despite you trying to manage them, then it is important to check in with your GP because we would want to investigate that further.

“Ultimately, you want to find out what is the root cause of this and is it something more serious? We would do tests like checking for a bacterium called Helicobacter pylori, which increases the production of acid. We may refer you for a gastroscopy. This is a camera test that goes into the stomach to see is there any inflammation, any ulcers, anything more serious.” Dr Punam then went on to disclose details of an innovative new test. “There is a really exciting pilot at the moment that is being tried out by the NHS across pharmacies in England,” she explained.

“And it is to try to identify any early changes that could increase your risk of oesophageal cancer. It’s called the sponge on a string test. And it involves putting a tiny capsule that’s attached to a thread down through the mouth into the stomach. It opens up like a tiny little sponge. It takes little cells from the stomach and the lining of your food pipe, your oesophagus. We pull it back out, and essentially, it’s easy if any cellular changes have happened. This is fantastic. If it is successful and it gets rolled out, we could pick up changes much earlier on.”

What alternative approaches exist besides medication?

Dr Punam said: “At the end of the day, medications are great, but there’s lots of things that we can do every day in our lifestyles that make a massive, massive difference. The first thing is if you are struggling with heartburn, indigestion, acid reflux, then eat smaller portions.

“If you eat big, heavy meals, you can actually put a lot of pressure on your stomach. Again, we’re going back to that valve, which can become a bit lax and cause acid to track up. Avoid lying down after a meal for at least three to four hours. When we lie flat, the sphincter relaxes, and acid can return to the oesophagus.

“If you have symptoms, prop up your pillows so your chest is slightly higher than your waist, so you’re just slouched up a little bit. Again, avoid lying flat. It really, really works a treat. Don’t wear tight clothes. We all want to loosen that button on your jeans after a meal, but actually just get into looser clothing because tight clothes can actually put a lot of pressure on your stomach as well.

“Gentle teas like chamomile work really well. Ginger tea is fantastic. Chamomile works really well, ginger tea is fantastic. A lot of people turn to mint. Now mint is great if you’ve got IBS or tummy cramps, but actually for reflux it can make the problem worse. So stick to ginger tea or chamomile tea.

“Avoid certain foods as well. Knowing your triggers. So keep a diary. I’m a big one for diaries. Look at when you get your symptoms, what have you had or done that day that could have exacerbated them. Taking them into your doctor is a real help to us. And that and also managing your weight. I think that goes without saying can make a big difference.”