RONI CARYN RABIN
International Herald Tribune
Long-term use of drugs to remedy heartburn can lead to complications.
The first time Jolene Rudell fainted, she assumed that stress as a medical school student had gotten to her. Then, two weeks later, she lost consciousness again.
Blood tests showed Ms. Rudell's red blood cell count and iron level were dangerously low. But she is a hearty eater (and a carnivore), and her physician pointed to another culprit: a popular drug used by millions of Americans like Ms. Rudell to prevent gastroesophageal acid reflux, or severe heartburn.
Long term use of the drugs, called proton pump inhibitors, or PPIs, can make it difficult to absorb some nutrients. Ms. Rudell, 33, has been taking these medications on and off for nearly a decade. Her doctor treated her anemia with high doses of iron, and recommended she try to manage without a PPI, but that's been difficult, she said.
As many as four in 10 Americans have symptoms of gastroesophageal reflux disease, or GERD, and many depend on PPIs like Prilosec, Prevacid and the famous "the purple pill," Nexium, to reduce stomach acid. These are the third highest-selling class of drugs in the United States, after antipsychotics and statins, with over 100 million prescriptions and $13.9 billion in sales in 2010, in addition to over-the-counter sales.
But in recent years, the Food and Drug Administration has issued numerous warnings about PPIs, saying long-term use and high doses have been associated with an increased risk of bone fractures and infection with a bacterium called Clostridium difficile that can be especially dangerous to elderly patients.
Studies have shown long-term PPI use may reduce the absorption of important nutrients, vitamins and minerals, including magnesium, calcium and vitamin B12, and might reduce the effectiveness of other medications.
Other research has found that people taking PPIs are at increased risk of developing pneumonia; one study even linked use of the drug to weight gain.
Drug company officials dismiss such reports, saying they do not prove the PPIs are the cause of the problems.
But while using PPIs for short periods of time may not be problematic, the drugs tend to breed dependency, experts say, leading patients to take them for far longer than the recommended eight to 12 weeks; some stay on them for life. Many hospitals have been starting patients on PPIs as a matter of routine, to prevent stress ulcers, then discharging them with instructions to continue the medication at home.
"Studies have shown that once you're on them, it's hard to stop taking them -- it's almost like an addiction," said Dr. Shoshana J. Herzig of Beth Israel Deaconess Medical Center in Boston.
PPIs work by blocking the production of acid in the stomach, but the body reacts by overcompensating and, she said, "revving up production" acid-making cells. "You get excess growth of those cells in the stomach, so when you unblock production, you have more of the acid-making machinery," she said.
Moreover, proton pump inhibitors have not been the wonder drugs that experts had hoped for. More widespread treatment of GERD has not reduced the incidence of esophageal cancers. "When people take PPIs, they haven't cured the problem of reflux -- they've just controlled the symptoms," said Dr. Joseph Stubbs, an internist in Albany, Georgia, and a former president of the American College of Physicians.
And PPIs provide a way for people to avoid making difficult lifestyle changes, like losing weight or cutting out the foods that cause heartburn, he said. "People have found, 'I can keep eating what I want to eat, and take this and I'm doing fine,"' he said. "We're starting to see that if you do that, you can run into some risky side effects."
Dr. Greg Plotnikoff, a physician who specializes in integrative therapy at the Penny George Institute for Health and Healing in Minneapolis, said, "We put people on PPIs, and we ignore the fact that we were designed to have acid in our stomach."
Stomach acid is needed to break down food and absorb nutrients, he said, as well as for proper functioning of the gallbladder and pancreas. Long-term of use of PPIs may interfere with these processes, he noted. And suppression of stomach acid, which kills bacteria and other microbes, may make people more susceptible to infections, such as C. difficile.
Taking PPIs, Dr. Plotnikoff said, "changes the ecology of the gut and actually allows overgrowth of some things that normally would be kept under control."
(C) 2012 International Herald Tribune. via ProQuest Information and Learning Company All Rights Reserved
Photo Credit: morgueFile
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