PPIs (proton pump inhibitors)
Medicines that strongly reduce stomach acid secretion, very effective for reflux, but whose prolonged use affects the absorption of several micronutrients.
PPIs (omeprazole, pantoprazole, esomeprazole and related drugs) block the enzyme responsible for acid secretion in the stomach. They are among the most prescribed medicines in the world and are very effective for gastro-oesophageal reflux and ulcers.
Their value is not in question: within their indications and for a defined period, the balance of benefit to risk is favourable. The issue is long-term treatment, often renewed for years without review.
Reducing acidity also reduces the absorption of nutrients that depends on it. This is the central nutritional link: stomach acid releases vitamin B12 from dietary protein and helps the absorption of non-haem iron, calcium and magnesium. B12 and magnesium deficiencies on long-term PPIs are documented and appear in monitoring recommendations.
Two other points are worth knowing: acidity acts as a barrier against ingested micro-organisms, and reducing it alters the gut microbiome. Finally, stopping abruptly after prolonged use causes rebound acidity that can feel like a relapse, which is why a gradual reduction is advisable, always with a doctor. Never stop a prescribed treatment on your own.