Prilosec titration

My wife has been on Prilosec for close to 15 years.  Though a number of doctors are aware of it, their "line" has been that it's better than running the risk of esophageal cancer...so stay on it.  That is not an acceptable answer for us since 2 other doctors have recently warned us about the long-term dangers of no hydrochloric acid being produced in the stomach--everything from auto immune type reactions to improper absorption of nutrients since enzymes can't do the job as effectively without the acid present. In fact, these doctors have quoted studies that show that that reflux is more related to a "lack" of enough stomach acid rather than too much.  But I digress...

The problem has been that the natural/nutritional replacements recommended (so as to replace the Prilosec and coat the stomach lining) include DGL which carries a warning for those with high blood pressure (for which my wife is being treated).  The next logical step for us is to "step down" the percentage of Prilosec slowly over time by pulling the capsules apart and removing, say, 10% of the medication every 2-4 weeks.  
But what do you think would be the best way to eliminate Prilosec from her regimen?  Thanks.

[Kevin Pho, MD]

In general, long-term treatment with PPIs like Prilosec is safe.  However, it is associated with some conditions, such as B-12 deficiency, colitis, as well as atrophic gastritis.

There are no clear recommendations as to how to titrate off PPIs.  Some physicians do a "step-down" approach.  This involves an incremental decrease in PPIs, and re-evaluation every 2-4 weeks.    If symptom-free, the dose of PPI can be further decreased or discontinued.

Some physicians simply do a trial off medication, with the need for maintainence medication dependent on recurrent symptoms.  Recurrence of symptoms within 3 months of stopping the medication is an indication for continuing an acid-suppressant.

The best course should be discussed with your gastroenterologist or personal physician.

Followup with your personal physician is essential.

This answer is not intended as and does not substitute for medical advice - the information presented is for patient education only. Please see your personal physician for further evaluation of your individual case.

Kevin, M.D.
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