“Seven to 30 per cent Indians suffer from a condition called GERD or Gastro-Esophageal Reflux Disease,” said Dr Shriram Nene, cardiac, thoracic and vascular surgeon in a video on his YouTube channel.
As such, many people resort to popping antacids at the first mention of heartburn or acidity. However, this is not just a cause of concern as it highlights an underlying gut issue, but can also cause kidney problems, warn experts.
What causes heartburn, GERD?
The stomach makes acid to enable one to digest food and remove bacteria. But in some cases, the stomach ends up making too much acid, which can cause discomfort.
As per Dr Nene, symptoms of GERD are
*Burning in the chest after a meal
*Bitter or sour taste in the mouth
*Nausea and vomiting
When diet and lifestyle changes may not help, healthcare provider may prescribe a type of medicine called proton pump inhibitors (PPIs).
What are proton pump inhibitors (PPIs)?
PPIs are drugs used to treat acid peptic disease. These drugs are safe and effective in most patients. However, there have been some concerns about their impact on kidneys, said Dr Sashi Kiran A, consultant nephrologist, Yashoda Hospitals, Hyderabad.
Impact of PPIs on kidneys
“The impact of PPIs on kidneys may be in two ways. The first is acute interstitial nephritis. This is an allergic reaction to the PPI leading to the swelling of the kidney and worsening of its function. Prompt recognition and withdrawal of the PPI would help the kidney to recover completely. In some instances, this condition needs to be treated with corticosteroids. This condition is not dose-dependent and can recur with a second exposure to the drug,” said Dr Sashi Kiran A.
The expert added that the second impact could be in the form of increased risk of incident chronic kidney disease (CKD), CKD progression, and end-stage renal disease, though these are not yet proven.
“This doesn’t mean that everyone using PPIs would develop CKD. But it’s important for all users to know that there may be a risk. The exact mechanism of how this occurs is still being studied. There is a possibility that the weak association found between PPI use and its impact on renal function may be due to a methodology limitation or otherwise known as a confounding aspect. Further research is needed to get a clear idea about this association. Till that time, it’s prudent to use PPIs under strict medical supervision,” mentioned Dr Kiran A.
Using an antacid without the doctor’s consultation can also lead to osteoporosis that can further cause hip fractures in elderly people as it blocks the absorption of calcium and iron in the stomach, said Dr Roy Patankar, director and gastroenterologist, Zen Multispeciality Hospital.
“Antacid will lead to magnesium deficiency inviting cardiac problems like arrhythmia (irregular heartbeats). Even low magnesium levels can cause kidney problems. Dementia, lung infections, and osteoporotic fractures in elderly are common on long-term PPI. Patients with cardiac arrhythmias are also at risk due to changes in magnesium,” said Dr Patankar.
Dr Dilip M Babu, consultant nephrologist, Yashoda Hospital, Hyderabad, added that further studies are needed to understand the relation between PPI use and the development and worsening of CKD. “One study detected a graded association between the duration of PPI exposure and risk of renal outcomes among those exposed to PPI for more than 30 days. Further studies are needed to help better define an etiologic relationship between PPI use and the development and worsening of CKD. Future research should evaluate whether limiting PPI use reduces the incidence of CKD,” said Dr Babu.
Who should avoid antacids?
Those with kidney and liver diseases, having heart problems, or high blood pressure should avoid antacids as some contain high levels of sodium, which could make you feel unwell. Take them only after consulting the doctor, said Dr Patankar.
Popping these tablets can give rise to bigger health issues, said Dr P N Gupta, director and HOD, Nephrology, Paras Hospitals, Gurugram. “Different medicines have different dosages. Omeprazole has 20 miligram once daily and pantoprazole has 40 miligram once daily. All these antacids generally have one dosage,” he said.
Instead of reaching out for pills, tablets and syrups, it is important to make lifestyle tweaks.
As per Dr Nene,
*Do not sleep within 30 minutes of eating.
*Wear loose-fitting clothes
*Avoid alcohol, tobacco, and chocolate
*Eat smaller portions more often
*Avoid greasy, spicy, and fatty food
Chew slowly: Take your time at every meal.
Make lifestyle changes to keep weight under control, said Dr Nene.
Dr Patankar also suggested that one should avoid eating acidic foods carbonated drinks or sugary beverages, and onions.
“Exercise daily. Do not sleep immediately after eating food,” Dr Patankar said.