REFLUX & PROTON PUMP INHIBITORS (PPIs)

Proton Pump Inhibitors Reduce the Size and Acidity of the Acid Pocket in the Stomach
The article examines how proton pump inhibitors (PPIs) affect the gastric acid pocket—a region in the stomach believed to be a source of acid reflux. The study found that PPIs significantly reduce both the size and acidity of this acid pocket, which may contribute to their effectiveness in treating gastroesophageal reflux disease (GERD). These findings suggest that PPIs not only decrease overall stomach acid production but also specifically target the acid pocket, potentially improving GERD management.

The lowdown on low stomach acid
Low stomach acid (hypochlorhydria) means your stomach doesn’t make enough hydrochloric acid to digest food properly—which can cause symptoms like bloating, cramps, gas, reflux, heartburn, undigested food in stool, fatigue, and bad breath. Because stomach acid also helps absorb key nutrients such as protein, iron, calcium, and B‑vitamins, inadequate acid can lead to deficiencies and problems like anemia and brittle bones. Low levels of acid also weaken your natural defenses, allowing harmful bacteria to survive, multiply, and potentially cause SIBO or infections. Common causes include aging, chronic stress, fatigue, H. pylori infection, autoimmune conditions, stomach surgery, and prolonged use of acid-suppressing medications like PPIs.

Proton pump inhibitor use: systematic review of global trends and practices
This article provides an overview of proton pump inhibitors (PPIs), medications commonly used to reduce stomach acid. While effective in the short term, long-term use of PPIs has been associated with various risks, including nutrient deficiencies, gastrointestinal infections, and potential kidney issues.

Increased Incidence of Small Intestinal Bacterial Overgrowth During Proton Pump Inhibitor Therapy
The study found that long‑term use of proton pump inhibitors (PPIs), which reduce stomach acid, significantly increases the risk of Small Intestinal Bacterial Overgrowth (SIBO). Using the glucose hydrogen breath test, researchers observed a higher rate of bacterial overgrowth in patients on extended PPI therapy. The findings suggest that suppressing stomach acid—an essential barrier to bacterial overgrowth—may inadvertently promote SIBO, which can cause symptoms like bloating, gas, and nutrient absorption issues.

Intestinal Dysbiosis Secondary to Proton-Pump Inhibitor Use
Long-term use of proton pump inhibitors (PPIs), which suppress stomach acid, can disrupt gut microbial balance—known as dysbiosis—which is linked to increased risk of various infectious and inflammatory conditions like Clostridioides difficile infection, small intestinal bacterial overgrowth (SIBO), spontaneous bacterial peritonitis, community-acquired pneumonia, hepatic encephalopathy, and worsened inflammatory bowel disease outcomes. Studies show that PPI use significantly raises levels of potentially harmful bacteria while reducing beneficial anti-inflammatory microbes suggesting that acid suppression may underlie these microbial shifts and associated health risks.

The Effect of Ginger (Zingiber officinalis) and Artichoke (Cynara cardunculus) Extract Supplementation on Functional Dyspepsia: A Randomised, Double-Blind, and Placebo-Controlled Clinical Trial
The study tested whether taking a supplement made from ginger and artichoke extracts would help people with functional dyspepsia (indigestion without a clear physical cause). The group taking the ginger + artichoke supplement had significantly better improvements in symptoms like nausea, fullness, epigastric pain, and bloating compared to placebo. The researchers concluded that the combination seems safe and effective for treating functional dyspepsia.

Review article: the clinical pharmacology of proton pump inhibitors
This article explains how proton pump inhibitors (PPIs) — drugs that reduce stomach acid — work in the body and how they behave over time (absorption, activation, how long they act, etc.). It describes that PPIs block the stomach’s acid-producing pump, which reduces acid secretion and helps treat conditions like ulcers and reflux. The review also highlights that, because they greatly lower stomach acid, PPIs can change the gut environment — potentially allowing more bacteria to survive and grow in the small intestine (raising the risk of bacterial overgrowth) and affecting nutrient absorption and other long-term safety aspects.

The role of pH in symptomatic relief and effective treatment of gastroesophageal reflux disease
This review highlights the central role of gastric pH in managing GERD. It explains that successful therapy is not just about reducing acid, but maintaining an elevated pH to minimize esophageal exposure to acid. The authors summarize evidence showing that drugs with prolonged acid suppression, such as certain PPIs, achieve more consistent symptom relief and mucosal healing than shorter-acting medications, underlining the importance of both potency and duration in GERD treatment.

Nocturnal recovery of gastric acid secretion with twice‑daily proton‑pump inhibitors
The study found that for many patients with Gastro‑oesophageal reflux disease (GERD), even taking acid‑suppressing medication (a Proton‑pump inhibitor, PPI) twice daily may not sustain suppression of stomach acid overnight — a phenomenon called “nocturnal gastric acid breakthrough.” This means that despite treatment, the stomach pH can drop below levels considered safe for acid reflux control, exposing the oesophagus to acid when patients are sleeping.