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Commentary warns of unexpected consequences of proton pump inhibitor use in reflux disease
November 02, 2009Alexandria, VA - Despite being highly effective and beneficial for many patients, unexpected consequences are emerging in patients who are prescribed proton pump inhibitors (PPIs) for reflux diseases. Physicians are warned to monitor these effects and prescribe these medications carefully, according to a new commentary published in the November 2009 issue of Otolaryngology - Head and Neck Surgery.
According to the authors, gastroesophageal reflux(GERD) and laryngopharyngeal reflux (LPR) are diseases that have undergone a remarkable growth in public health relevance over the last 20 years. While it has been known historically that more than 50 percent of adults in Western countries have occasional symptoms of reflux, there has been a more than four-fold increase in how many patients seek medical care for their symptoms.
PPIs are a class of important and generally safe medicines that prevent the release of stomach acid, which is one cause of the burning sensation many reflux patients experience. PPIs are among the most widely prescribed classes of medications for GERD and LPR diseases. But according to the authors, there is a growing body of literature demonstrating that acid is not the only causal agent of tissue damage in reflux disease, and that PPIs are not effective at treating all cases of GERD and LPR.
In addition to the evidence that acid isn't the only contributing agent in reflux disease, the authors' search of recent research on PPIs pointed out that there are many unexpected consequences and side effects from this class of drugs. They can include: increased rates of hip fractures, possibly related to altered calcium absorption; possible but yet unproven altered vitamin B12 and iron absorption, related to alteration of the gastric pH; increased odds of acquiring nosocomial Clostridium difficile-associated diarrhea; and increased odds of contracting community-acquired pneumonia.
The authors say while it may be premature to make global recommendations about PPI prescribing patterns, they applaud the idea of raising clinical awareness of this medication class and its potential unexpected consequences. In addition, appropriate evaluation and monitoring of patients taking PPIs will be important in determining the need and duration of the use of the medications. The authors further advise physicians treating reflux disease patients to weigh the risks of treatment versus the risks of not treating the disease, and to consider a goal of a more holistic approach that includes diet and lifestyle modification. These additional steps could prove beneficial in lowering healthcare costs associated with reflux diseases, and encourage patients to continue practicing behaviors that would improve their overall health.
American Academy of Otolaryngology -- Head and Neck Surgery
In addition to the evidence that acid isn't the only contributing agent in reflux disease, the authors' search of recent research on PPIs pointed out that there are many unexpected consequences and side effects from this class of drugs. They can include: increased rates of hip fractures, possibly related to altered calcium absorption; possible but yet unproven altered vitamin B12 and iron absorption, related to alteration of the gastric pH; increased odds of acquiring nosocomial Clostridium difficile-associated diarrhea; and increased odds of contracting community-acquired pneumonia.
The authors say while it may be premature to make global recommendations about PPI prescribing patterns, they applaud the idea of raising clinical awareness of this medication class and its potential unexpected consequences. In addition, appropriate evaluation and monitoring of patients taking PPIs will be important in determining the need and duration of the use of the medications. The authors further advise physicians treating reflux disease patients to weigh the risks of treatment versus the risks of not treating the disease, and to consider a goal of a more holistic approach that includes diet and lifestyle modification. These additional steps could prove beneficial in lowering healthcare costs associated with reflux diseases, and encourage patients to continue practicing behaviors that would improve their overall health.
American Academy of Otolaryngology -- Head and Neck Surgery
Reflux Disease Current Events and Reflux Disease News RSSReflux esophagitis due to immune reaction, not acute acid burn, UT Southwestern researchers report
Contrary to current thinking, a condition called gastroesophageal reflux disease (GERD) might not develop as a direct result of acidic digestive juices burning the esophagus, UT Southwestern Medical Center researchers have found in an animal study.
Barrett's esophagus patients have same survival rates as general population
New Mayo Clinic research has found that survival rates of patients with Barrett's esophagus, which can be a precursor for esophageal cancer, are no different than the survival rates for the general population.
GERD negatively impacts sleep quality, results in considerable economic burden
There has been much debate about the relationship between gastroesophageal reflux disease (GERD) and sleep.
GERD patient satisfaction hinges on medication type and physician bedside manner
Patient satisfaction with their medications and the quality of interactions with their doctor reflect the success of gastroesophageal reflux disease (GERD) therapy, according to a new study in Clinical Gastroenterology and Hepatology, the official journal of the American Gastroenterological Association (AGA) Institute.
University of Saskatchewan and Canadian Synchrotron researchers shed light on esophageal disease
Canadian Light Source (CLS) staff scientist Luca Quaroni and Dr. Alan Casson, Head of the Department of Surgery at the University of Saskatchewan (U of S) used the synchrotron's infrared microscope to identify tissue afflicted with a condition known as Barrett's Esophagus from chemical fingerprints associated with the disease, which can lead to esophageal cancer.
NEJM study finds radiofrequency ablation can reverse Barrett's esophagus, reduce cancer risk
Patients who have gastroesophageal reflux disease (GERD) for a prolonged period have an increased risk of developing Barrett's esophagus, a pre-cancerous condition where the tissue lining the esophagus becomes damaged by stomach acid and transformed into something like the inside of the stomach.
Obesity predicts inadequate bowel prep at colonoscopy
Obesity is an independent predictor of inadequate bowel preparation at colonoscopy, and the presence of additional risk factors further increases the likelihood of a poorly cleansed colon.
Technique eradicates problems in most patients with Barrett's esophagus
A procedure that uses heat generated by radio waves to treat Barrett's esophagus, a condition caused by acid reflux (severe heartburn), can eliminate signs of the potentially cancer-causing disorder and reduce the risk that the disease will progress.
Use of acid-suppressive medications associated with increased risk of hospital-acquired pneumonia
Hospitalized patients who receive acid-suppressive medications such as a proton-pump inhibitor have a 30 percent increased odds of developing pneumonia while in the hospital.
Study examines reliability of clinical and pathological diagnoses of Barrett's esophagus
In a review of more than 2,000 patients coded for Barrett's esophagus, electronic diagnosis overestimated the prevalence of the disease according to researchers in California.
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