The Impacts of Proton Pump Inhibitors on IBS

As I've mentioned several times before on here, in addition to having IBS, I also have GERD. This shouldn't be surprising – as GERD and IBS often tend to intersect – and if you have one you are much more likely to have the other.

Yet, in the struggle to simultaneously manage both my IBS and GERD, I have run into some roadblocks and complications. Namely, it seems that many of the first-line defenses and medications one takes for GERD can instigate IBS symptoms. And at least for me, that can often be the case, especially of Proton Pump Inhibitors, or PPIs.

What are Proton Pump Inhibitors?

Proton Pump Inhibitors work exactly as their name suggests: shutting down the proton pump in the stomach, and in turn, heavily reducing if not altogether eliminating the production of stomach acid. PPIs accomplish this by blocking an enzyme in the wall of the stomach that produces the acid. While this may benefit some people with GERD symptoms (at least in the shorter term), it can also flare symptoms associated with IBS. The most prominent side effects listed for taking PPIs, after headache, include diarrhea, constipation, gas/bloating, nausea, and vomiting – all of which are also the major symptoms of IBS.

As you can imagine, those of us with IBS have very sensitive GI tracts – so taking ANYTHING new has the potential to disrupt or exacerbate our symptoms. Yet, this can be especially the case regarding a medication that disrupts or changes our digestive processes.

Research about PPIs

One study published in 2010 theorized that PPIs may contribute to the development of SIBO (Small Intestine Bacterial Overgrowth), thereby also contributing to the development or intensification of IBS as IBS patients are much more likely to suffer from SIBO. The study pontificates: "...SIBO might be a byproduct of the disproportionate use of proton pump inhibitors (PPIs) in IBS, as follows: (1) IBS patients are more likely than controls to receive PPI therapy; (2) PPI therapy may promote varying forms of SIBO by eliminating gastric acid, and (3) existing studies linking SIBO to IBS have not adjusted for or excluded the use of PPI therapy. When linked together, these premises form the basis for a simple and testable hypothesis: the relationship between SIBO and IBS may be confounded by PPIs."¹

My experience with PPIs

Personally, I never had much luck with PPIs. I tried them a few times for a few weeks in my early 20s when reflux flares were rarer for me. They would help a bit, the situation would temporarily resolve and I would move on. But as my GERD worsened over the years, extended use of PPIs, I tried a longer-term regimen and had to switch brands several times to find one that worked at all. However, it only worked for about 8 weeks, at which times its effect began to wear off and my symptoms started returning despite that I was still taking it. I spent a few more months on it, but gradually lowered my dose when I realized it wasn't working at all anymore. You have to lower doses gradually or you can have a "rebound" effect where the stomach acid actually comes back stronger if you quit suddenly or taper off too quickly.

No matter the types or brands I tried, they either didn't help at all or only helped temporarily before their effect wore off. Not only that, at least in the beginning of trying each new type, I would experience a modest uptick in IBS symptoms (usually this would calm down as my body acclimated to the medication). Ultimately, the benefits did not outweigh the side effects and I weaned myself off PPIs for good in my early 30s and now mostly avoid them (the last time I went on them for a week was well over 5 years ago).

Of course, my experience can't be applied to everyone. For some, PPIs are more effective and do not aggravate their other health issues (or at least substantially). But for me at least, they were only helpful in the short term and then stopped being helpful at all – and I would even say seemed to bother my IBS, but make my GERD worse overall over time. so quitting them was the right move for me.

Have you ever taken PPIs? Did they help or hurt your IBS? Did they help your GERD? Please feel free to share your experiences in the comments below!