as seen on TVWhat the heck?  What am I talking about?  Actually…I’m having a little fun with acronyms that are so common in medicine by spelling out the letters as opposed to just using the acronyms ZE & PPI.

Z.E……are the initials for Zollinger-Ellison Syndrome, and rare condition of persisting and recurring excess stomach ulcerations due to massive overproduction of the hormone Gastrin, which is the hormone that stimulates acid by the stomach.   Patients with Z.E. make way too much gastrin which leads to too much acid, and it is this series of events that leads to unending stomach ulcerations  so severe that short of removing the stomach, in the past there was no treatment for this condition.

PPI’s….are the initials for one of the most ubiquitous groups of medication in the world today; the proton pump inhibitors.  These medications, which you know by their trade names as Prilosec, Nexium, Prevacid, Protonix, Aciphex, Zegerid, are among the most widely prescribed medications in the world, and also are among the most lucrative; there is a multibillion dollar industry for these products alone.  They  inhibit stomach acid by blocking the production of the Hydrogen ion by cells in the stomach lining (the parietal cells to be exact) and it is by blocking this Hydrogen ion (which has only 1 proton in it’s nucleus….thus the proton pump nomenclature), it prevents the stomach from forming acid.

So…putting the above two medical topics together you can understand that the PPI medications, by blocking the proton pump, were the ‘cure’ for ZE Syndrome and when they were developed in the 1980’s, they were a major breakthrough in the treatment of the uncommon ZE Syndrome.   But in turn they were found to be also the treatment for more run-of-the-mill stomach ulcers and acidity syndromes, which are among the most common maladies of humanity.  These medications were so good, in fact, that they became the de facto treatment for these conditions.  Initially, the mighty strength of these medication suggested that their use could continue for only a few weeks with safety, but fortunately for the inventors of the PPI’s, they turned out to be very safe for long-term use, and this spawned their multibillion dollar profits.

This backdrop is important in understanding the current controversy that surrounds PPI medications, as every few months there is a headline in the general press incriminating PPI medications for side effects that are significant, worrisome, and that their use should be limited.  Just this week there was a report that PPI medications are associated with kidney issues.  You can read that article abstract >>>HERE<<<

I think there is not question that PPI medication, like all medications, have unintended consequences and that they need to be used when needed and not to excess so that these side effects can be avoided, but the intensity with which these medications are attacked and that their negative aspects are promoted in the press is rather unusual, and I think there are interesting reasons why this is the case….and I’ll talk more about that in my next post ZEE EEE PEE PEE EYE TWO