Problems With Acid Reflux In Infants
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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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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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