Tag Archives: PPIs

Routine Acid Reflux Drug Use Linked to Kidney Problems

Routine use of proton pump inhibitors, common over-the-counter medications used to treat acid reflux, can increase the risk of kidney failure four-fold.

Researchers examined health data on more than 190,000 patients over a 15-year period in a retrospective study. None of the patients had existing kidney disease at the start. Researchers compared patients who were eventually given a PPI and those who weren’t ever given one. Common PPIs include Prevacid (lansoprazole), Prilosec (omeprazole) and Nexium (esomeprazole).

Results, published in Pharmacotherapy, found that those on a PPI had a 20% increased risk of chronic kidney diseased compared with those not on the drug. In addition, those on a PPI were four times as likely to experience kidney failure. The study authors noted that the risks were highest in those 65 and older.

Although PPIs are only meant for short-term use, overuse of the medications are as high as 70% of patients.

Lead author David Jacobs, PharmD, PhD, assistant professor of pharmacy practice at the University of Buffalo School of Pharmacy and Pharmaceutical Sciences, noted that doctors need to be educated on the dangers of overuse of PPIs and deprescribing initiatives developed.

Last month, a study that analyzed adverse events reports sent to the FDA found that PPIs were associated with an increased risk of kidney disease.

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Heartburn Drug, Broken Bones and Pharma Marketing: The Whistleblower

By Noah Nathan

Several studies have found that proton pump inhibitors (PPIs), a class of acid reflux (heartburn) drugs such as Prevacid (lansoprazole) and Nexium (esomeprazole), can cause bone fractures. But are people understanding that their bone fractures could be related to their use of PPIs?

In my new book, Heartburn, Broken Bones, and the False Claims Act, I share my story as a whistleblower and former Takeda Pharmaceuticals sales representative. It claims there is a potential risk of bone fractures from physicians unknowingly prescribing 60 mg of the prescription PPI Dexilant (dexlansoprazole) instead of the FDA-approved dose of 30 mg for GERD (gastroesophageal reflux disease, or acid reflux). The book includes court documents, FDA documents, legal articles and medical journals, as well as information from Takeda. It encourages patients taking Dexilant who suffer bone fractures to submit their story to AppleQD.com, a website I run to document the issue.

In the book, I explain how even with a warning in the package insert regarding bone fractures, Takeda only sampled and promoted the 60 mg dose of Dexilant. By doing so, Takeda may have been promoting a health risk, as broken bones suffered by GERD patients on Dexilant may have been a result of taking the higher dose over an extended period of time.

Takeda claims that regardless of how Dexilant was promoted, it is the physician’s responsibility to know how to prescribe the drug. The book provides evidence that physicians rarely read package inserts and argues that representatives were instructing physicians to give patients a sample of Dexilant 60 mg, even though GERD is only indicated for a 30 mg dose.

Higher Dexilant Dose Raises Bone Fracture Risk

I am sharing this information to make the public aware of the issue, not to place blame on the prescribing physicians, as the majority of prescribers were and are unknowingly writing for the double dose. If a physician believes that Dexilant is the correct medication for the patient, the FDA-approved 30 mg dose should be used for GERD. Current patients who have been on 60 mg for an extended period of time might have bone density issues, and possibly have had bone fractures as a result.

Interestingly, the book explains that as a condition for approval in 2009, the FDA required Takeda to conduct a post-marketing bone fracture study. The study, which only included postmenopausal women and compared Dexilant to placebo for 26 weeks, was just published late last year. It found “significant increases in markers of bone turnover in women given PPI therapy compared with women given placebo, but levels remained within the normal reference range.”

From the FDA documents discussed, one of the initial FDA investigators was skeptical about Dexilant due to the bone fracture risk. As a result, a warning on the package insert states: “Several published observational studies suggest that PPI therapy may be associated with an increased risk for osteoporosis-related fractures of the hip, wrist or spine. The risk of fracture was increased in patients who received high-dose, defined as multiple daily doses, and long-term PPI therapy (a year or longer). Patients should use the lowest dose and shortest duration of PPI therapy appropriate to the conditions being treated.”

Improving Whistleblower Success Against Pharmaceutical Companies

In my whistleblower case against Takeda, which I petitioned the US Supreme Court to hear (it denied the petition), the issue of how to interpret a provision of the False Claims Act was the focus. The book has two goals: 1) To make the public aware of a potential health concern; 2) To add an amendment to clarify “Rule 9(b)” of the False Claims Act to better enable whistleblowers to succeed against pharmaceutical companies. I believe that American patients and health care providers don’t want big pharmaceutical companies winning legal challenges on a technicality while continuing to potentially put patients at risk. Because the issue is hiding in plain sight, most people don’t think twice about it. There have been over 30 million prescriptions filled for Dexilant since 2009, most at the 60 mg dose.

There are currently around 500,000 Americans on Dexilant. The majority of those are prescribed a 60 mg off-label dose, since that dosage is only indicated for healing erosive esophagitis, with an eight-week duration. Dexilant loses patent protection in 2020 and PAR Pharmaceuticals has already secured generic exclusivity for the first 180 days, but surprisingly, they will only be making a 60 mg dose.

An article in the Yale Journal of Biology and Medicine states that “in persons with GERD symptoms, about 20% are found to have erosive esophagitis.” Since only 20% are found to have the symptoms for which the 60 mg dose is indicated, why is PAR Pharmaceuticals not making the FDA-indicated 30 mg dose for GERD? I believe it is because Takeda Pharmaceuticals only promoted and sampled the 60 mg dose.

If a patient has been on Dexilant 60 mg for over a year and has broken a bone, they should contact their physician, report it to the FDA and go to AppleQD.com to document the issue. And if you are on Dexilant for GERD at 60 mg, discuss going on a lower dose with your healthcare provider. Your bone health could depend on it.

Noah Nathan spent 20 years in pharmaceutical sales, 15 of which were with Takeda Pharmaceuticals. He is the author of the book Heartburn, Broken Bones, and the False Claims Act.

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Acid Reflux Drugs Tied to Higher Kidney Disease Risk

An analysis of an FDA side effects database has found that taking proton pump inhibitor (PPI) drugs such as Prilosec (omeprazole) and Nexium (esomeprazole), used to treat acid reflux, is associated with an increased risk of kidney disease.

Researchers examined data from the FDA Adverse Event Reporting System (FAERS) database. They narrowed their study to reports on 43,000 people who took a PPI and no other medications and 8,000 people who took histamine-2 receptor antagonists (H2 antagonists), another class of acid-reducing drugs that includes Pepcid (famotidine) and Zantac (ranitidine).

Results, published in Scientific Reports, found that those who took only PPIs were 28.4 times more likely to have chronic kidney disease, 35.5 times more likely to report end-stage renal disease and 4.2 times more likely to have acute kidney disease compared to those on H2 antagonists.

“Although [H2 antagonists] have not been shown to be as effective as PPIs, they might be considered as alternatives for patients who are at high risk for developing renal and electrolytes imbalances,” the researchers concluded.

A 2017 study also found that long-term use of PPIs can lead to kidney damage.

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3 Super Bowl-Watching Health Tips

When you think of the Super Bowl, concerns about health usually don’t come to mind. But with hundreds of millions of people watching the big game from home and doing a considerable amount of eating and drinking during it, it’s important to keep in mind that overindulging can potentially lead to some health problems, albeit short-term ones. Here are some tips to enjoying the Patriots-Rams matchup this weekend without any health hazards.

Keep Bacteria Away From Your Food

In the US, Super Bowl Sunday is the second-largest food consumption day of the year. Chicken wings are synonymous with football games, and more than 1.25 billion of them were eaten over the 2014 Super Bowl weekend, according to the National Chicken Council. Whenever handling raw food, there is a risk of bacterial contamination. If you are cooking up your own wings – or any other food – be sure to wash your hands with soap and warm water for at least 20 seconds both before and after handling the food. Also, do not allow raw or uncooked food to come in contact with cooked foods, as this can lead to food poisoning . Use separate plates and utensils for raw and cooked foods.

If you are cooking wings, foodsafety.gov says the frying oil should be at 375 degrees F before putting in the wings, and they should be cooked to an internal temperature of 165 degrees. Also, make sure not to put too many wings in the fryer at one time, as doing so can lead to some being undercooked.

If you have an array of food items out, it’s important that hot foods have a heat source to keep them hot and cold ones are on ice. Perishable foods should be kept out for two hours max. After that, throw them out.

You’ve Got Heartburn and Indigestion

Chowing down during the game is as much a part of the Super Bowl as the halftime show and the commercials. But overindulging can lead to discomfort and even a stomach ache in your gut. To avoid this, try to pace yourself so you don’t overeat. Of course, this is easier said than done, so if you find yourself with heartburn or indigestion, you might head to your bathroom for some Tums, Mylanta or Nexium.

Tums and Mylanta are antacids and work to neutralize acids in your stomach. Nexium (esomeprazole) is known as a proton-pump inhibitor (PPI), and works by cutting down acid production in the stomach. You should know that routine use of PPIs has been linked to a higher risk of death compared to another class of acid reducers known as H2 blockers, such as Zantac (ranitidine). Long-term PPI use has also been linked to kidney damage and weakened bones.

If you’d like to get rid of heartburn without turning to medication, there are a few natural options. Baking soda mixed with water can help neutralize stomach acid. Eating a little bit of ginger may also help, though avoid drinking ginger ale as carbonated drinks can actually make the problem worse. Diluting a bit of apple cider vinegar in water might do the trick, and some people say that licorice root can also help.

Go Easy on the Alcohol

Drinking beer during the game is a popular pastime, reinforced by the slew of beer ads shown during commercial breaks. As the game lasts about three hours (or more, if there is overtime!), that’s a long time for drinking. Although you might be persuaded to drink throughout the game, don’t. Not only might it lead to a hangover the next day, all that alcohol can seriously tax your liver — and beer has a lot of calories anyway.

If you insist on drinking a lot, have a glass of water with or after each alcoholic beverage. That’s because alcohol is a diuretic and removes water from your blood through urine. This can lead to dehydration, which contributes to a hangover. Also, don’t drink on an empty stomach. Having some food in your stomach will slow the absorption of alcohol into your bloodstream – but it still can’t prevent you from getting drunk if you drink too much too quickly.

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Healthy Alternatives to Holiday Heartburn

In honor of thanksgiving, MedShadow Foundation founder Su Robotti and Content Manager Jonathan Block discuss how to fight that overstuffed feeling without reaching for harsh medication like PPIs (Nexium, Prilosec, Prevacid, etc.).

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Many Medications Taken Longer Than Recommended

Many people continue to take prescription drugs months after clinical guidelines recommend, a practice that increases the risk of side effects from individual drugs as well as from drug interactions.

New research examines the issue of legacy prescribing, which is when drugs are taken for longer than needed to treat a condition. A new study, published in the Annals of Family Medicine, examined 50,000 patients in Canada who were prescribed drugs that are typically taken for more than three months but not indefinitely. The drug classes were antidepressants; proton-pump inhibitors (PPIs), which are used to treat heartburn and acid reflux; and bisphosphonates, which treat osteoporosis by stemming bone density loss.

Nearly half of patients on an antidepressant – 46% – were on it for more than 15 months, even though a current recommendation states they should be prescribed it for only six months after a mood episode is resolved. PPIs shouldn’t be taken for longer than three months. However, 45% of patients were prescribed them for longer than 15 months. The recommendation for bisphosphonate prescriptions is 5.5 years, yet 14% of people on those drugs took them for at least six months longer than that.

For example, long-term use of PPIs has been linked to several health issues. In one study, patients who had taken the drugs for at least five years had a higher risk of developing kidney disease than those on another type of acid-reducing medication. Another study found long-term PPI use may be associated with an increased risk for stomach cancer.

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Quick Hits: Antibiotics and Childhood Obesity, Alternative Therapies Don’t Cure Cancer & More

Children that are given antibiotics before the age of two are more likely to become obese in childhood, according to a new study. Researchers looked at the medical records of more than 333,000 toddlers. Those that were given an antibiotic by the time they were two years old were 26% more likely to eventually be diagnosed with childhood obesity. The risk increased the more antibiotic prescriptions a child received and the more classes of antibiotics that were prescribed. The study also found that infants given acid-reducing medications also had a higher likelihood of obesity, though the increased risk was only about 2%. The researchers said that antibiotics and acid-reducing medications can kill bacteria in the gut involved in regulating body weight. Posted October 30, 2018. Via Gut.

Nearly four out of 10 Americans incorrectly believe that cancer can be cured through alternative therapies alone, even though studies have shown this is not the case. A survey, commissioned by the American Society of Clinical Oncology (ASCO), found that younger people (18-53 years old) are more likely to believe in alternative medicine as a cancer cure, and 22% of people who have or had cancer do as well. Some of these alternative therapies include supplements, changes in diet and oxygen or enzyme therapy. However, a study published last year found that cancer patients who relied on alternative therapies alone were 2.5 times more likely to die than those who received standard cancer treatment, such as chemotherapy, radiation or surgery. Another study published this year found that patients with one of four types of cancer who used alternative treatment were twice as likely to die as those that used conventional treatment. Posted October 30, 2018. Via ASCO.

About three out of four doctors have received some type of benefit, such as free drug samples, free meals or payments as consultants, from drug companies. A national survey of 700 doctors found that drug samples were the most common benefit. About half of the physicians surveyed said they received a meal or beverages in their office courtesy of a pharmaceutical company. Only 4% reported receiving money for consulting work. The team that conducted the study said that receiving drug samples is linked to doctors prescribing more expensive, brand-name drugs rather than cheaper generic drugs. They also noted that compared to a national physician survey conducted in 2009, fewer doctors reported receiving pharmaceutical industry benefits. Posted October 18, 2018. Via Dartmouth Institute for Health Policy and Clinical Practice.

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4 Drugs That Interact with Anxiety Meds

If you suffer from anxiety, panic disorder or insomnia, your doctor may have prescribed you a tranquilizer belonging to a class of drugs known as benzodiazepines.

Drugs such as Xanax (alprazolam), Valium (diazepam), Ativan (lorazepam), and Klonopin (clonazepam) are some of the most-prescribed medicines – more than 133.4 million such prescriptions were filled in the US in 2014. As with any medication, drug interactions can occur if you take a benzo with another medication, and in certain cases, may be life-threatening.

With benzos, there are 2 areas of concern. The first is that interactions might increase the effects of the drug, which can result in oversedation, accidents and/or overdose. The second is that interactions could decrease the amount of a benzo in the bloodstream of a patient who has been on the drug for a long time, which can result in withdrawal symptoms, the most severe being seizures and death. Here are 4 drug classes that can have dangerous interactions with benzodiazepines.

1. Opioids

Opioids such as OxyContin (oxycodone), morphine, and Vicodin (hydrocodone) are painkillers. Katy LaLone, MD, a consulting psychiatrist with A Resilient Space Psychiatry Consultants in Cleveland, says combining benzos with “other sedative medications, especially opioids, can cause cardiorespiratory depression,” putting patients at risk of overdose and death. In fact, 75% of benzodiazepine-related deaths also involve an opioid. This combination is so dangerous that the FDA issued a black box warning in 2016 about prescribing the 2 drug classes together.

Dr. LaLone has even seen overdoses in patients who are on stable doses of the two drugs after developing a “compromised cardiorespiratory status, such as the flu or undiagnosed sleep apnea.” She adds, “overdose is almost always accidental.”

2. Insomnia drugs

Prescription drugs that treat insomnia, known as “Z-drugs” have a mechanism of action similar to benzos. These drugs include Ambien (zolpidem), Lunesta (eszopiclone), and Sonata (zaleplon). Dr. LaLone sees the combination of benzos and Ambien quite frequently in her clinical practice, usually in patients receiving prescriptions from more than one doctor. Patients are often prescribed benzodiazepines for anxiety and a “Z-drug” for insomnia, not realizing the drugs are similar in action.

She notes this “dangerous combination can cause amnestic episodes (blackout spells),” and she almost never prescribes the 2 drug classes together except in special cases. A 2017 study looking at emergency room visits for adverse events from benzos and/or “Z-drugs” found that the combination of the 2 drug classes led to a 4-fold risk for serious outcomes.

3. Proton Pump Inhibitors (PPIs)

These drugs, such as Prilosec (omeprazole), Nexium (esomeprazole), Prevacid (lansoprazole), and Protonix (pantoprazole), are used to treat acid reflux. They can increase blood levels of benzodiazepines by interacting with the same liver enzymes that clear them from the body. This can result in worsening side effects of benzodiazepines including confusion, sedation, dizziness, falls and impaired driving.

The most common offenders are Prilosec and Nexium. Mary Hall, a retiree living in North Carolina, was prescribed Prilosec by her doctor while taking clonazepam. She said, “The clonazepam started to build up, and I started feeling stoned like I was taking more doses of a benzo. I actually had to skip my night dose of the clonazepam and stop taking the Prilosec after three days.” She also developed a “horrible headache” that lasted for several days. She notified her doctor, and he was unaware of the potential interaction.

‘After the first dose of cipro, my heart started beating super fast, I felt really dizzy and had to hold onto the walls for balance. The world was spinning, and I was very shaky’

4. Fluoroquinolone Antibiotics

Fluoroquinolones include Cipro (ciprofloxacin), Levaquin (levofloxacin), and Avelox (moxifloxacin). They compete for the same binding site as benzodiazepines, which means 1 drug blocks the effect of the other. In this case, the fluoroquinolones block the benzodiazepine leading to acute withdrawal in those who are dependent on the benzo. There have been reports in medical literature and online communities of long-term benzodiazepine patients experiencing withdrawal symptoms after taking these antibiotics.

Kristie Walker, a former medical office biller who now lives in Florida, learned about the interaction firsthand after being prescribed ciprofloxacin for a urinary tract infection. She had been taking Xanax for around 15 years. “After the first dose of cipro, my heart started beating super fast, I felt really dizzy and had to hold onto the walls for balance. The world was spinning, and I was very shaky” she says. She informed her doctor of her symptoms and stopped taking the ciprofloxacin after 2 days.

At that point she was profoundly ill. Her heart rate went up to 200 beats per minute just walking from room to room, she was unable to eat due to severe nausea, and she was ultimately hospitalized. Her symptoms were so severe she contemplated suicide. “I thought I was going to die”, she says. After Walker began to research her symptoms online, she found an article on the interaction between benzos and fluoroquinolones and realized the antibiotic had caused her to have acute benzodiazepine withdrawal.

How to Avoid Dangerous Interactions?

There are numerous ways you can protect yourself from dangerous drug interactions involving benzos. Dr. LaLone recommends that you only take medications that are prescribed to you, and take them only as prescribed. Second, obtain your prescriptions from 1 physician and pharmacy, and have regular doctor visits to assess your medication regimen. Third, exercise caution with use of other sedating medications, especially opioids. And finally, inform your doctor of all medications you are taking, including over-the-counter medications and supplements.

It is also important to know that if you are considering stopping a benzo after being on it for a long time, it should be tapered to avoid the risk of severe withdrawal, which can result in seizures and even death.

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How Herbs Can Help You Get Off Acid Reflux Drugs

When Rocky Angelucci first went on Prilosec for his acid reflux, he considered it “a miracle drug,” wiping out his sore throat and other symptoms. But over the next decade, whenever he tried to go off the drug, he’d feel even worse than before he started taking it.

“I felt horrible burning, choking reflux,” says Angelucci, 53, a technical writer and author in Texas. “It felt like I had swallowed a potato and it was stuck halfway down, along with burning acidity.”

Angelucci finally was able to quit Prilosec (omeprazole) — one of the most popular over-the-counter (OTC) drugs for acid reflux — for good 8 years ago. What made the difference? First, he radically changed his diet, cutting grains, white sugar and processed foods. Second, to get through the rebound reflux stage, he used herbal remedies, including licorice chews and apple cider vinegar.

Now, he says, reflux is “a distant memory.”

Side Effects Associated With Long-Term PPI Use

Millions of Americans take medications such as Prilosec and Nexium (esomeprazole) – which are proton pump inhibitors (PPIs) that work by suppressing stomach acid. Long-term use of PPIs has been associated in recent years with conditions such as osteoporosis,  stomach and other infections, kidney problems and heart disease, among others.

Some patients may need to get off PPIs due to having precancerous changes to the esophagus or other serious conditions, experts say. Many who want to try getting off PPIs often find that rebound hyperacidity makes this challenging. A 2006 study showed only 27% of long-term users who tried to stop PPIs were successful.

One way PPI users can more easily wean off the drug is to use herbal medicine, say integrative medicine specialists.

“Herbs and supplements have some mechanisms of action on the esophagus and stomach that’s a little different than pharmaceuticals,” says David Kiefer, MD, a family physician trained in integrative medicine and clinical assistant professor at the University of Wisconsin Department of Family Medicine and Community Health.

Herbs Ease Inflammation, Coat Tissue on GI Tract

Some herbs can ease inflammation on the surface of the gastrointestinal (GI) tract, Kiefer says. These anti-inflammatory herbs include chamomile tea and licorice root (specifically, the deglycyrrhizinated type, also referred to as DGL).

Other herbs work to coat the tissue in the esophagus and stomach, Kiefer says. These include slippery elm root bark and marshmallow root, which come in powdered form that can be mixed with water. “They make kind of a slurry which goes down and coats whatever it touches — the back of your throat, your esophagus, your stomach,” says Kiefer.

Another coating type of herb, says Kiefer, is aloe vera gel — the type formulated for upper GI tract problems, not the kind you get in a bottle in your store’s sunburn section.

Besides these herbs, Kiefer recommends melatonin, which studies have found may be as effective as Prilosec at reducing GERD (gastroesophageal reflux disease) symptoms.

David Rakel, MD, professor and chair in the Department of Family and Community Medicine at the University of New Mexico, adds Iberogast to the list of natural products that can help people get off PPIs. Iberogast is the brand name of a compound comprised of 9 herbs; studies show it’s effective in relieving gastric regurgitation and other symptoms.

How to Use Herbals to Transition Off PPIs?

Rakel says the key is to set expectations. “I say, ‘Hey, this is one of those things where you’re going to get worse before you’ll feel better, but if you can hang in there for 1-1/2 to 2 weeks, that hyperacidity rebound effect should go away.’”

Rakel says it’s important for patients to taper off PPIs slowly, first cutting the dose, if possible, and then taking it every other day. He usually recommends patients stay with one herbal remedy while weaning off PPIs.

Kiefer, on the other hand, says patients can combine herbs. He suggests using anti-inflammatories such as chamomile or DGL plus melatonin during the medication tapering process. Once the PPI is gone, herbs that act to coat the GI tract (such as aloe vera or marshmallow root) can be added, he says. (These can interfere with the absorption of medication, so should be taken at least an hour before or after taking any pills.)

Becky Fishman used a process like this to finally get off PPIs after a dozen years. She says her doctor hadn’t explained how, but her father – also a reflux sufferer — helped her work out a Nexium step-down plan. The 46-year-old North Carolina medical writer used DGL lozenges and aloe vera to help alleviate symptoms during her transition. Some mild reflux symptoms remained, though, which she then mostly eliminated by cutting back on carbs.

Indeed, say Rakel and Kiefer, changing what you eat can also help avoid reflux symptoms, whether it’s avoiding trigger foods or eating less to lose weight. Other non-herbal remedies they advise include acupuncture, stress management (mindfulness and meditation, for instance) and lifestyle changes, such as exercising.

What If Acid Reflux Symptoms Return?

If you are off your medication for a few weeks and your reflux symptoms have come burning back, Rakel and Kiefer say patients should be evaluated to see why. Some patients may have hiatal hernias or precancerous changes to the esophagus, for example, which may mean they need to go back on acid-blocking medication or explore other treatments.

What Kiefer and Rakel won’t do is recommend you stay on a regular regimen of herbs to fight reflux. If you have occasional mild heartburn, you can take an herbal remedy, they say, but if your problem is severe and ongoing, you want to find out what the cause is – not just mask its symptoms.

“I would be doing a disservice if I just swapped out a drug for an herb,” says Kiefer.

Angelucci says he decided to go off his PPI because he didn’t want to be on a drug for the rest of his life; he wanted to see if he could address the reason for his symptoms. In his case, it turned out to be his diet, he says.

“Dietary changes were my root cause,” he says. “But the supplements were a dramatic help during that really difficult roller-coaster period.”

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Surgery an Option for Acid Reflux When PPIs Fail

Having surgery may work better than continuous drug treatment for patients with gastroesophageal reflux disease – also known as acid reflux — whose heartburn fails to improve with proton pump inhibitors (PPIs), according to new research.

Up to 40% of patients with reflux symptoms don’t receive much relief from PPIs, the first-line treatment for reflux. With very few other treatment options for these patients, researchers have suggested that doctors offer fundoplication surgery as an option.

“Fundoplication [reflux surgery] had fallen from favor with gastroenterologists, largely because it had been used inappropriately and can have bad side effects,” Stuart Spechler, MD, of Baylor University Medical Center in Dallas, told Medscape Medical News. “But gastroenterologists have to appreciate that there is a role for invasive treatment in this disease.”

The research team recruited 366 patients with refractory heartburn to undergo medical therapy. Researchers discovered that in 288 cases, the heartburn stemmed from a condition other than acid reflux. The team then examined the remaining 78 patients whose heartburn was due to acid reflux.

Of these, 27 underwent laparoscopic Nissen fundoplication (reflux surgery); 25 received active medical treatment with 20 mg of the PPI Prilosec (omeprazole) twice a day plus up to 20 mg of baclofen 3 times a day or, in the case of baclofen failure, up to 100 mg of desipramine at bedtime; and 26 received placebo.

The rate of success at 1 year was significantly higher in the fundoplication group (66.7%) than in the active treatment (28%) or placebo groups (11.5%), results presented at the recent Digestive Disease Week indicated.

PPIs have been linked to a host of side effects. Last year, a study found that compared to another class of drugs used to treat acid reflux, H2 blockers, those on PPIs had a higher risk of death.

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Long-Term Use of a Category of Acid Reflux Drugs Can Boost Stomach Cancer Risk

Long-term use of a class of drugs popularly used to control acid reflux and heartburn can significantly increase one’s risk of developing stomach cancer.

Researchers looked at more than 60,000 adults who had taken a combination of a proton-pump inhibitor (PPI) and two antibiotics to kill H. pylori bacteria for 7 days. Eliminating that bacteria from the gut can significantly lower a person’s risk of developing stomach cancer. However, many people continue to take a PPI regularly after the bacteria has been eliminated, often for years.

The patients were then monitored for an average of 7.5 years. The researchers compared those who were taking PPIs with another drug class used to decrease acid production in the gut, H2 receptor antagonists (H2 blockers).

PPIs and H2 blockers are widely available over the counter. Common PPIs include Nexium (esomeprazole), Prevacid (lansoprazole) and Prilosec (omeprazole). Popular H2 blockers include Pepcid (famotidine), Tagamet (cimetidine) and Zantac (ranitidine).

Those on PPIs had a 2.4 times higher risk of developing stomach cancer, the researchers reported in the journal Gut. However, taking an H2 blocker was not linked to a higher risk.

The risk also increased the more frequently a PPI was used. Daily use was associated with a 4.5 times higher risk of developing stomach cancer compared with weekly use. Also, the longer a PPI was used, the greater the risk.

After more than a year of use, the risk of stomach cancer increased 5-fold; 6-fold after 2 or more years; and more than 8-fold after at least 3 years.

Other research has indicated long-term use of PPIs can lead to other side effects, including pneumonia, heart attack and bone fracture. The study’s authors say that doctors should exercise caution when telling patients to take a PPI for a long period of time.

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Diet Change More Effective Than Meds for Acid Reflux

If you suffer from acid reflux and turn to medication for relief, new research indicates that a change in diet is more effective in reducing that burning sensation than drugs, but without the side effects.

People with laryngopharyngeal reflux – acid that travels up the esophagus to reach the throat – that closely followed a Mediterranean diet saw a better improvement in reflux symptoms than those who were taking proton-pump inhibitors (PPIs), a common class of medication used for acid reflux, according to a new study published in JAMA Otolaryngology-Head & Neck Surgery.

PPIs are available over-the-counter and by prescription, and are also extensively used to treat gastroesophageal reflux disease (GERD). Some of the most popular ones are Nexium (esomeprazole), Prilosec (omeprazole) and Prevacid (lansoprazole).

The Mediterranean diet is plant and whole foods-based, and focuses on eating fruits, vegetables, grains and nuts. Dairy and animal products – such as beef, chicken and pork — are largely cut out. If you have acid reflux, you should also avoid alcohol, coffee, tea, carbonated drinks and greasy, fatty and fried foods.

Researchers enrolled 184 people with laryngopharyngeal reflux. Participants either received a PPI and standard advice to reduce reflux or were treated with a 90% plant-based, Mediterranean diet, alkaline water and standard advice.

About 63% of those on the Mediterranean diet achieved a meaningful reduction in reflux symptoms, compared to 54% who took a PPI, results showed. The average reduction in the Reflux Symptom Index for those who changed their diet was 40%. For those who took a PPI, it was 27%.

The study’s lead author, Craig H. Zalvan, MD, medical director of The Institute for Voice and Swallowing Disorders at Phelps Memorial Hospital in Sleepy Hollow, NY, used to be one of the biggest prescribers of PPIs in the area. But he thought there had to be a better treatment for reflux and through research, developed a plant-based diet for some of his patients.

“Although effective in some patients, I felt medication couldn’t be the only method to treat reflux and recent studies reporting increased rates of stroke and heart attack, dementia and kidney damage from prolonged PPI use made me more certain,” Zalvan said in a statement. “The results we found show we are heading in the right direction to treating reflux without medication.”

A study earlier this year found that people taking PPIs for at least 5 years had a higher risk of developing kidney disease and kidney injury than those taking H2 blockers, such as Pepcid (famotidine) and Zantac (ranitidine). And a study released in 2016 found that those who regularly take PPIs are more likely to see their bones weaken than those who weren’t taking the drugs.

Use of PPIs over long periods of time has also been associated with pneumonia, fractures of the hip, wrist and spine, and iron and vitamin B12 deficiencies, according to the FDA.

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