Heart-burn cure may be worse than cause

The Seattle Times ^ | December 20, 2005 | Lindsey Tanner

[neverdem]

Associated Press

CHICAGO — Holiday revelers beware: Seasonal indulgences such as eggnog and fruitcake might give you heartburn, but the acid-fighting medicine you take for relief might lead to something worse, researchers say.

People on popular prescription drugs for treating acid reflux — Prilosec, Prevacid and Nexium — seem more prone to getting a potentially dangerous diarrhea caused by the bacterium Clostridium difficile, new research shows. C-diff, as it's known, can cause severe diarrhea and crampy intestinal inflammation called colitis.

Dr. Sandra Dial and colleagues at McGill University in Montreal examined data on more than 18,000 patients in the United Kingdom from 1994 to 2004. During that time, 1,672 cases of C-diff were diagnosed, and the numbers increased from less than 1 per 100,000 in 1994 to 22 per 100,000 last year.

Patients with prescriptions for powerful acid fighters called proton pump inhibitors, which include Prilosec and Prevacid, were almost three times more likely to be diagnosed with the bug than those not taking the drugs.

Those on less potent prescription drugs called H2 receptor antagonists, which include Pepcid and Zantac, were two times more likely than nonusers to get C-diff infections.

The widely used and heavily promoted drugs reduce levels of gastric acid that can keep C-diff at bay.

Dr. L. Clifford McDonald, a researcher at the federal Centers for Disease Control and Prevention, said proton pump inhibitors recently were implicated in a C-diff outbreak in Maine.

"It's not surprising in my mind that there could be some association" with acid-fighting drugs, said McDonald.

Most study patients hadn't been recently hospitalized and weren't taking antibiotics, both risk factors for C-difficile infections. The study will appear in Wednesday's Journal of the American Medical Association.

A co-author is a consultant for AstraZeneca, which markets Prilosec and Nexium, and Altana Pharma, which makes and markets another prescription heartburn drug, Protonix, in Europe.

A spokesman for Wyeth, which markets Protonix in the United States, said the company hadn't seen the research and declined to comment.

AstraZeneca spokeswoman Cindy Callaghan said, "Further research is needed ... to determine the validity of a potential link."

Dr. Michael Brown, a gastroenterologist at Rush University Medical Center in Chicago, who was not involved in the study, said short-term use of potent acid-fighting drugs is unlikely to increase infection risks in otherwise healthy people. But he said the study results suggest doctors and patients "have to think twice about using such heavy acid suppression" over the long term.

[Banjoguy]

You, of course, are somewhat right about all that.

Many cases of acid reflex have nothing whatsoever to do with diet or fluid intake.

I would argue that, anecdotally speaking, most of the people who are complaining about heartburn are more than a little overweight, have emotionally based eating habits, have a non-intellectual approach to food selection, and sit around entirely too much.

When people say eat better and exercise it kind of reminds me of when lay people prescribe the same thing for severe depression and think it's going to work.

It's usually a matter of degree and only a fool would think that it will work every time to cure what I call lifestyle maladies. Regardless, intellectualizing food intake and a regular, rational exercise routine, are in the enlightened self-interest category of lifestyle choices, will often produce feelings of well being, thereby ameliorating common depression, (probably will not help severe depression.)

Thanks for your input and suggestion that it is somewhat situation dependent (not feeling picked on).

[Bella_Bru]

Speaking of donuts, Blue didn't bring any on Tuesday. He brought fruitcake, cookies, and candy. Good ol' Blue. I love him. :-)

[steve86]

I would argue that, anecdotally speaking, most of the people who are complaining about heartburn are more than a little overweight, have emotionally based eating habits, have a non-intellectual approach to food selection, and sit around entirely too much.

Maybe so, I wouldn't know. My case is unrelated to any of that and is a reaction to a long-term prescription medication.

[LadyDoc]

Ah, but I'm old enough to remember when we treated ulcers and heartburn with Tums and milk...

And we saw a lot of Kidney stones from too many Tums...and ended up doing surgery for bleeding ulcers and severe esophagitis...

There is surgery for Reflux, but it is MAJOR, and rarely done anymore...before Prilosec, we had to do it sometimes...not only for pain, but for repeat aspiration pneumonia in children with Cerebral palsy...

Now they can do the surgery with a small hole, so maybe it will come back into fashion..

Two things about reflux/heartburn...one, if you cough at night, sleep with a pillow (pneumonia can be caused by reflux even with PPI's) Two: Long standing heartburn can cause precancerous changes of the esophagus...and these pre cancerous changes go back to normal on the PPI's...

Finally, long term PPI's decrease absorbtion of Vitamin B12...since you can't absorb B12 very well without acid...now, about 30 percent of the elderly don't have acid normally, and we haven't seen any a major problems with PPI's, but you might want to consider B12 drops if you have been on PPI's for a couple years...