By Joseph E. Scherger, MD, MPH
Core Faculty, Eisenhower Health Family Medicine, Residency Program, Eisenhower Health Center, La Quinta, CA; Clinical Professor, Keck School of Medicine, University of Southern California, Los Angeles
Summary Points
- A group of researchers in Thailand performed a randomized, double-blind study of the effectiveness of curcumin, an active ingredient in the spice turmeric, with omeprazole for treating functional dyspepsia.
- A total of 151 patients completed the study. The authors divided these participants into three groups: curcumin alone, omeprazole alone, and a combination of the two.
- Investigators defined functional dyspepsia using the Rome IV Criteria.
- Acid reflux is a common diagnosis for these patients in the United States. Proton pump inhibitors, such as omeprazole, are prescribed most commonly because of their effectiveness. Kongkam et al reported that in Thailand, turmeric often is used for dyspepsia — but not by physicians because of a lack of studies showing evidence of efficacy. The intent of this paper was to provide such evidence.
- At the end of 28 days and 56 days, there was control of symptoms in all three groups that was comparable. The authors concluded curcumin and omeprazole demonstrate comparable efficacy for treating functional dyspepsia. There was no synergistic effect of using both together.
SYNOPSIS: In a randomized controlled trial, curcumin demonstrated comparable efficacy to omeprazole in treating dyspepsia and acid reflux.
SOURCE: Kongkam P, Khongkha W, Lopimpisuth C, et al. Curcumin and proton pump inhibitors for functional dyspepsia: A randomized, double blind controlled trial. BMJ Evid Based Med 2023;28:399-406.
Agroup of researchers in Thailand performed a randomized, double-blind study of the effectiveness of curcumin, an active ingredient in the spice turmeric, with omeprazole for treating functional dyspepsia. A total of 151 patients completed the study. The authors divided these participants into three groups: curcumin alone, omeprazole alone, and a combination of the two.
Investigators defined functional dyspepsia using the Rome IV Criteria: postprandial fullness, early satiation, epigastric pain, or burning without evidence of structural disease. Acid reflux is a common diagnosis for these patients in the United States. Proton pump inhibitors (PPIs), such as omeprazole, are prescribed most commonly because of their effectiveness. Kongkam et al reported that in Thailand, turmeric often is used for dyspepsia — but not by physicians because of a lack of studies showing evidence of efficacy. The intent of this paper was to provide such evidence.
At the end of 28 days and 56 days, there was control of symptoms in all three groups that was comparable. The authors concluded curcumin and omeprazole demonstrate comparable efficacy for treating functional dyspepsia. There was no synergistic effect of using both together.
Commentary
PPIs are highly effective gastric acid blockers and control the symptoms associated with acid reflux. These drugs were introduced 30 years ago to prevent and heal peptic ulcers and other acid peptic problems. They were not intended for long-term use.1 However, PPIs often are prescribed long term. This is because when patients stop taking PPIs, there is a rebound of symptoms and the dietary causes of the problem have not been addressed.
There are well-known side effects to the long-term use of PPIs. Stomach acid plays a role in digestion and overall health. When that is blocked, certain nutrient deficiencies occur, including vitamin B12, vitamin C, calcium, iron, and magnesium.2 There also is a higher risk for fractures and for a variety of infections.3 An association of PPIs with dementia risk has been controversial. A recent widely publicized study again suggests such an association.4
This study by Kongkam et al suggests turmeric, with its active ingredient curcumin, may be comparably efficacious. This is excellent news, since turmeric provides other numerous health benefits as an anti-inflammatory agent. My elderly patients use it instead of nonsteroidal anti-inflammatory drugs for chronic arthritis, including relieving associated pain. The National Center for Complementary and Integrative Health offers a review of the many known and proposed benefits.5
If patients are on PPI medications chronically, they must be weaned to avoid rebound symptoms. Typically, that weaning process is four to six weeks.6 Start patients on turmeric and an anti-inflammatory diet. Then, patients step down their PPI intake — every other day for two weeks, then twice a week for one to two weeks, and finally once a week for one to two weeks before stopping altogether. When acid symptoms recur, besides the turmeric I ask patients to drink more water. Famotidine 20 mg is effective for as needed use, such as after social events. Weaning patients off long-term PPI medications is a way of helping them become healthier and avoiding serious risks. n
References
- Strand DS, Kim D, Paura DA. 25 years of proton pump inhibitors: A comprehensive review. Gut Liver 2017;11:27-37.
- Nehra AK, Alexander JA, Loftus CG, Nehra V. Proton pump inhibitors: Review of emerging concerns. Mayo Clin Proc 2018;93:240-246.
- Ngamruengphong S, Leontiadis GI, Radhi S, et al. Proton pump inhibitors and risk of fracture: A systematic review and meta-analysis of observational studies. Am J Gastroenterol 2011;106:1209-1218.
- Northuis CN, Bell E, Lutsey P, et al. Cumulative use of proton pump inhibitors and risk of dementia: The atherosclerosis risk in communities study. Neurology 2023;101:e1771-e1778.
- National Center for Complementary and Integrative Health. Turmeric. https://www.nccih.nih.gov/health/turmeric
- Chutkan R. The Anti-Viral Gut: Tackling Pathogens from the Inside Out. Avery; 2022.
In a randomized controlled trial, curcumin demonstrated comparable efficacy to omeprazole in treating dyspepsia and acid reflux.
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