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Despite link to hip fractures, 'what's the other choice?'
By Chris Emery
sun reporter
Originally published January 8, 2007
When a recent study found that a popular class of heartburn drugs might weaken bones, Dorothea E. Kilner was alarmed, but not just because her medication could contribute to a hip fracture.
For Kilner and the millions of Americans who suffer from chronic heartburn, the greater threat may be losing access to prescription drugs such as Prevacid, Prilosec, Protonix and Nexium. They're far more effective than earlier generations of heartburn medication, according to doctors and to patients who rely on them for relief.
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"The real question is, what's the other choice?" said Dr. David B. Posner, chief of gastroenterology at
Kilner has already made up her mind. "I'm going to continue taking my Nexium because it works for me," said the 72- year-old Timonium resident. "The quality of life has improved for me by taking it."
Posner said the benefits of these drugs, known as proton pump inhibitors, or PPIs, outweigh the risks. While the study results announced Dec. 27 suggested that older people who take the drugs might want to take extra precautions to prevent bone loss, the link between hip fractures and the drugs is inconclusive, he said.
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For 20 years, Carol Epstein passed up coffee, salads, dairy and wheat because she feared the consequences.
"Stomach cramps and you might have diarrhea with it," she said.
It didn't keep carol home, but irritable bowel syndrome followed her on vacations to Egypt, Cambodia, India. Nothing helped, not even a restrictive diet. Then she met Dr. Mark Pimentel.
A breath test found an overgrowth of bacteria in Carol's stomach. Working on the theory that bacteria may cause IBS, Dr. Pimentel tested the antibiotic rifaximin on 87 patients. Nearly 40 percent saw major improvement.
"If you take the antibiotic for 10 days, patients got better, and they got better for 10 weeks after the antibiotic was stopped," he said.
Unlike other antibiotics, rifaximin is not absorbed into the bloodstream. It stays in the intestine, killing bacteria before passing through the digestive tract.
"Just to have the feeling that I'm going to eat something and not going to have cramps or run to the bathroom or have this trapped gas is a wonderful feeling," said Carol.
Carol's been pain-free for a year and a half.
Patients take the antibiotic for just 10 days, but the effects seem to last up to a year. A longer study is needed to verify the results.
The drug is FDA approved to treat traveler's diarrhea and is available by prescription under the brand name Xifaxan.
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The drugs are Aciphex, Nexium, Prevacid, Prilosec (called Losec in Europe), and Protonix. The drugs shut down the chemical "pump" needed by stomach cells to make acid. They are very effective for treating GERD (gastrointestinal reflux disease).
That makes the acid-fighting drugs very popular. Together they rang up nearly $13 billion in U.S. sales in 2005 -- a year in which American doctors wrote more than 95 million prescriptions for the drugs. Prilosec is now available over the counter.
Now a new study shows that when taken long term the drugs may have a side effect: hip fracture. People over age 50 who take the drugs for more than one year have a 44% increased risk of breaking a hip, find University of Pennsylvania researchers Yu-Xiao Yang, MD, and colleagues.
Taking proton-pump inhibitors at higher doses -- and for longer periods -- dramatically increases the risk. Long-term, high-dose use of the drugs ups the risk of hip fracture by 245%.
"Proton-pump inhibitor therapy is associated with a significantly higher risk of hip fractures, with the highest risk seen among those receiving high-dose proton-pump-inhibitor therapy," Yang and colleagues conclude.
The findings appear in the Dec. 27 issue of The Journal of the American Medical Association.
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NEW YORK (Reuters Health) - Overall, the use of drugs that reduce stomach acid, such as H2 blockers and proton pump inhibitors, do not increase the risk of cancer of the esophagus or stomach, according to a study reported in the journal Gut.
Common H2 blockers are ranitidine (Zantac) and cimetidine (Tagamet); and a common proton pump inhibitor is omeprazole (Prilosec).
"There have been concerns regarding the safety of long-time gastric acid suppression," senior investigator Dr. Mats Lindblad told Reuters Health. "I think our large study clearly suggests that long-time gastric acid suppression does not increase the risk" of cancer of the esophagus or stomach.
Lindblad and colleagues at the Karolinska Institute in Stockholm evaluated 7 years of patient data entered into the UK general practice database. The team identified 287 patients with esophageal cancer and 522 with stomach cancer. These subjects were compared with 10,000 randomly selected subjects without cancer.
The authors found some conditions for which acid-suppressing drugs are used, such as acid reflux disease, hiatal hernia and Barrett's esophagus, were associated with an increased risk of stomach and esophagus cancer. However, no apparent cancer risk was seen with other conditions, including peptic ulcer, gastritis, and indigestion. They found no evidence that the drugs themselves increased the risk.
These findings are in line with those of previous studies, continued Lindblad. The new information is that the cancer risk is probably due to underlying conditions, rather than an independent, harmful effect of these drugs.
In an interview with Reuters Health, Dr. Kenneth E.L. McColl, author of an accompanying editorial, agreed that the findings are consistent with such a conclusion.
However, McColl of the Western Infirmary, Glasgow, UK added that "a major weakness in the study is the relatively short duration of acid suppressive therapy examined. The development of cancer in humans is a slow process."
The period in question "is really too short to identify or exclude any direct effect between acid suppressive medication and" stomach or esophageal cancers.
SOURCE: Gut, November 2006.
© Reuters 2007. All Rights Reserved.
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