Common Heartburn Medicines May Link to Kidney Trouble

If you’re one of the millions of Americans who takes one of a class of anti-reflux meds such as Nexium, Prilosec and Prevacid, take heed: These drugs have been linked to higher odds of kidney trouble.

The study couldn’t prove cause-and-effect — it’s possible that folks who need these heartburn medicines are simply more prone to kidney disease for other reasons. But the review of data did show a link.

The medicines in question are called proton pump inhibitors (PPIs). They reduce stomach acid production and are among the most widely prescribed medications in the world.

According to a team led by Dr. Charat Thongprayoon, of Bassett Medical Center in Cooperstown, N.Y., recent research has suggested an increased risk of kidney problems for people who take the drugs, but those findings were inconsistent.

Probing deeper, the researchers reviewed data from five studies that included a total of nearly 537,000 people.

They found that people who took a PPI were a third more likely to develop chronic kidney disease or kidney failure than those who didn’t take the drugs.

The findings were to be presented Saturday at the annual meeting of the American Society of Nephrology (ASN), in New Orleans.

“This study demonstrates a significant association between the use of PPIs and increased risks of chronic kidney disease and kidney failure,” Thongprayoon said in an ASN news release.

He stressed that cause-and-effect wasn’t confirmed. However, Thongprayoon believes that doctors “should consider whether PPI therapy is indicated for patients. Chronic use of PPIs should be avoided if not really indicated.”

Two kidney specialists said the new research does have value.

“It is important to always evaluate potential side effects — not only of medications but of treatments and procedures in general,” said Dr. Ernesto Molmenti. He directs adult and pediatric kidney transplantation at Northwell Health in Manhasset, N.Y.

Dr. Maria DeVita helps direct kidney care at Lenox Hill Hospital in New York City. She noted that PPIs — some of which have gained over-the-counter status in recent years — “are one of the most commonly ingested medications worldwide.”

Also, DeVita said, “PPIs were originally used for a limited time, but now, people may continue to use them for years.”

While it remains to be proven that the drugs cause kidney trouble, “we should reconsider our prolonged use of PPIs from time to time to make sure that the benefits outweigh potential risks,” she said.

Experts note that findings presented at medical meetings are typically considered preliminary until published in a peer-reviewed journal.

Source: HealthDay


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Study: Prolonged Use of Certain Heartburn Meds May Increased Risk of Early Death

Dennis Thompson wrote . . . . . .

Popular heartburn medications like Nexium, Prilosec or Prevacid may increase your risk of early death when taken for extended periods, a new study suggests.

Further, the longer you take these drugs, known as proton pump inhibitors (PPIs), the greater your risk of early death, said senior researcher Dr. Ziyad Al-Aly. He is a kidney specialist and assistant professor of medicine with the Washington University School of Medicine, in St. Louis.

“There was a relationship between duration of use and risk of death,” Al-Aly said. “More prolonged use was associated with even higher risk.”

That said, Al-Aly pointed out that some patients really do need to take PPIs to deal with medical issues, even long-term.

“Proton pump inhibitors actually save lives,” Al-Aly said. “We don’t want to leave people with a scary message. If you need this drug and you’re under guidance of a doctor, you should continue to take your medication until otherwise advised.”

The study found that people taking PPIs for a year or more had a 51 percent increased risk of premature death, compared with 31 percent for people on the drugs for six months to a year, and 17 percent for three- to six-month users.

Short-term use of PPIs — up to 90 days — did not appear to affect death risk, the findings showed.

Proton pump inhibitors work by blocking the enzyme system that produces stomach acid. PPIs have become one of the most commonly used classes of drugs in the United States, with 15 million monthly prescriptions in 2015 for Nexium alone, the researchers said.

However, concerns about the drugs’ safety have been growing in recent years, as studies have linked PPIs to kidney disease, heart disease, pneumonia, bone fractures and dementia.

To take a broad look at PPIs and whether they increase a person’s chances of premature death, Al-Aly and his colleagues compared the medical records of nearly 276,000 users of PPIs against those of about 73,000 people who took another class of heartburn drug called H2 blockers.

Overall, PPI users have a 25 percent increased risk of premature death compared with people taking H2 blockers (such as Pepcid or Zantac), the investigators found.

The researchers calculated that for every 500 people taking PPIs for a year, there is one extra death that would not have occurred otherwise, Al-Aly said.

One doctor said the results should be heeded.

“This finding is certainly cause for concern and something that should be considered as doctors continue to prescribe PPIs at a high rate and often fail to discontinue these drugs in a timely fashion,” said Dr. Louis Cohen. He is an assistant professor of gastroenterology with the Icahn School of Medicine at Mount Sinai, in New York City.

At the same time, Cohen noted that people taking PPIs also tend to have many other health problems, and these might influence their risk of death as well.

No one is sure why PPIs might cause all these health problems or increase risk of early death, Al-Aly said. It is possible the drugs might cause cellular or genetic damage.

Even though this study could not prove a direct cause-and-effect relationship, Al-Aly noted that the increased risk with longer duration adds weight to concerns over the drugs’ safety.

“Why would prolonged use be associated with higher risk if there were no real relationship between exposure and untoward outcomes?” he said.

Recommended treatment regimens for most PPIs are relatively short, the researchers said. For example, people with ulcers are advised to take the drugs for only two to eight weeks.

But since the drugs are available over-the-counter, many people take PPIs for months or years to manage heartburn or acid reflux, Al-Aly said.

“If people find themselves taking proton pump inhibitors for an extended period of time with no valid need for doing so, or for symptoms that can be managed in other ways, that’s when there’s far more risk than any potential benefit,” Al-Aly said.

Cohen said that “there is little question that the short-term use of PPIs for many conditions can be beneficial to patients.”

And because “studies to demonstrate causal relationships between PPIs and death are not likely,” Cohen added, “the challenge to physicians should remain to use medications judiciously and continue to assess the benefit of a medication to a patient over time.”

The research was published online in the journal BMJ Open.

Source: HealthDay


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Instead of Treating Heartburn with a Pill, Try Diet and Exercise

Jane E. Brody wrote . . . . . .

Many Americans would rather take a drug than change their habits to control a persistent ailment. Yet, every medication has side effects, some of which can be worse than the disease they are meant to treat. Drugs considered safe when first marketed can turn out to have hazards, both bothersome and severe, that become apparent only after millions of people take them for a long enough time.

Such is the case with a popular class of drugs called proton pump inhibitors, or PPIs, now used by more than 15 million Americans and many more people across the world to counter an increasingly common ailment: acid reflux, which many people refer to as heartburn or indigestion.

These medications are now linked to a growing number of complications, ranging in seriousness from nutrient deficiencies, joint pain and infections to bone fractures, heart attacks and dementia. While definitive evidence for most of the risks identified thus far is lacking, consumers plagued by acid reflux would be wise to consider an alternative approach, namely diet and lifestyle changes that can minimize symptoms and even heal damage already done.

Acid reflux is more than just a nuisance. It involves the backward flow of stomach acid into the tissues above it. It results when the lower esophageal sphincter, a ring of muscle between the esophagus and the stomach, fails to close tightly enough to prevent the contents of the stomach from moving up instead of down. Sometimes, the upper sphincter, between the esophagus and the throat, malfunctions as well.

Acid reflux is a serious disorder that can and must be treated to prevent symptoms and stave off potentially life-threatening consequences. Known medically and commercially as GERD, the acronym for gastroesophageal reflux disease, repeated bathing of the soft tissues of the esophagus with corrosive stomach acid can seriously damage them and even cause esophageal cancer, which is often fatal.

Contrary to what many believe, heartburn is but one of the many symptoms of GERD, and failure to recognize the others when heartburn is not among them can result in harmful untreated reflux. In addition to indigestion, GERD can cause a persistent dry cough, sore throat, frequent throat clearing, hoarseness, burping or hiccups, bloating, difficulty swallowing and a sensation of a lump in the throat.

If, when faced with such an otherwise unexplainable symptom, your doctor fails to think of GERD as a possible reason, you might suggest it yourself. An examination of the esophagus may be the only way to find out if someone without obvious heartburn has acid reflux but doesn’t know it.

Dr. Jonathan Aviv, an ear, nose and throat specialist affiliated with Mount Sinai Icahn School of Medicine in New York, was in his mid-30s when he developed a frightening symptom that turned out to be caused by acid reflux. He was suddenly awakened one night gasping for air and feeling like he was being choked. Because he’d never complained of heartburn, his own doctor had trouble believing that acid reflux could be the explanation. Yet, treating this ailment brought relief and set Aviv on a yearslong journey to learn how best to manage it.

He has now written a book, The Acid Watcher Diet, that both explains how the varied symptoms of acid reflux arise, and details a program for healing and prevention that can help many, if not most, people avoid the medications commonly prescribed to treat it.

One characteristic often associated with acid reflux – being overweight, especially with abdominal obesity – largely explains why the condition has become so common in Western countries. Someone with a body mass index in the overweight range is almost twice as likely to have GERD as a person of normal weight. Losing weight is one of the best ways to find relief without having to rely on medication.

Quitting smoking, limiting alcohol and avoiding carbonated drinks are also important protective measures. Smoking and alcohol can loosen tension of the upper esophageal sphincter and cause symptoms of reflux such as hoarseness, postnasal drip and shortness of breath by irritating the mouth, larynx and trachea, Aviv reports.

Source: The Globe and Mail


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Popular Heartburn Medication May Increase Ischemic Stroke Risk

A popular group of antacids known as proton pump inhibitors, or PPIs, used to reduce stomach acid and treat heartburn may increase the risk of ischemic stroke, according to preliminary research presented at the American Heart Association’s Scientific Sessions 2016.

“PPIs have been associated with unhealthy vascular function, including heart attacks, kidney disease and dementia,” said Thomas Sehested, M.D., study lead author and a researcher at the Danish Heart Foundation in Copenhagen, Denmark. “We wanted to see if PPIs also posed a risk for ischemic stroke, especially given their increasing use in the general population.”

Ischemic stroke, the most common type of stroke, is caused by clots blocking blood flow to or in the brain.

Researchers analyzed the records of 244,679 Danish patients, average age 57, who had an endoscopy — a procedure used to identify the causes of stomach pain and indigestion. During nearly six years of follow up, 9,489 patients had an ischemic stroke for the first time in their lives. Researchers determined if the stroke occurred while patients were using 1 of 4 PPIs: omeprazole (Prilosec), pantoprazole (Protonix), lansoprazole (Prevacid) and esomeprazole (Nexium).

For ischemic stroke, researchers found:

  • Overall stroke risk increased by 21 percent when patients were taking a PPI.
  • At the lowest doses of the PPIs, there was slight or no increased stroke risk.
  • At the highest dose for these 4 PPI’s, stroke risk increased from 30 percent for lansoprazole (Prevacid) to 94 percent for pantoprazole (Protonix).
  • There was no increased risk of stroke associated with another group of acid-reducing medications known as H2 blockers, which include famotidine (Pepcid) and ranitidine (Zantac).

In comparison with non-users, PPI users were older and had more health conditions, including atrial fibrillation at baseline (3.4 vs. 3.8 percent). The study accounted for age, gender and medical factors, including high blood pressure, atrial fibrillation (irregular heart beat), heart failure and the use of certain pain relievers that have been linked to heart attack and stroke.

Authors believe that their findings, along with previous studies, should encourage more cautious use of PPIs. Sehested noted that most PPIs in the United States are now available over the counter.

“At one time, PPIs were thought to be safe, without major side effects,” he said, “This study further questions the cardiovascular safety of these drugs.”

Although their study did not find a link between H2 blockers and stroke, the authors could not say that this group of drugs would be better for patients than PPIs.

Doctors prescribing PPIs, should carefully consider whether their use is warranted and for how long: “We know that from prior studies that a lot of individuals are using PPIs for a much longer time than indicated, which is especially true for elderly patients.”

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Clues to How Popular Heartburn Drug Might Harm Arteries

A popular over-the-counter heartburn medication accelerated aging of blood vessel cells in lab tests, raising red flags about its long-term effect on heart health, researchers say.

Faster aging of blood vessel cells exposed to the antacid Nexium (esomeprazole) might potentially hinder the tasks these cells perform to prevent heart attack and stroke, the new study suggests.

These lab results could explain why other studies have shown increased risk of heart disease in people who use proton pump inhibitors (PPIs) — the class of heartburn medication that includes Nexium, said study senior author Dr. John Cooke.

“Our finding that the lining of blood vessels is impaired by proton pump inhibitors is a unifying mechanism for the reports that PPI users are at increased risk for heart attack, stroke and renal failure,” said Cooke, chair of cardiovascular sciences at the Houston Methodist Research Institute.

AstraZeneca, the maker of Nexium, responded with a statement noting that the study was conducted in a laboratory setting, “not in humans within a controlled clinical trial. Therefore, conclusions around cause and effect cannot be made.

“Patient safety is an important priority for AstraZeneca and we believe all of our PPI medicines are generally safe and effective when used in accordance with the label,” the drug maker said.

However, many people aren’t using PPIs in accordance with FDA guidelines, which in Nexium’s case would limit them to a four-week course of treatment three times a year, Cooke said.

“They are being used ubiquitously, for long periods of time. They aren’t being used as originally approved,” Cooke said.

Dr. P.K. Shah, director of the Oppenheimer Atherosclerosis Research Center at Cedars-Sinai Medical Center in Los Angeles, said these study results provide a reasonable explanation for how PPIs might affect the heart health of long-term users.

“We have clinical data that raises a suspicion that they might be bad if used long-term, and we have now experimental data that suggests a potential mechanism,” Shah said. “But we still have unanswered questions.”

For this study, Cooke and his colleagues cultured the cells that line the walls of blood vessels, which are called endothelial cells.

These cell cultures were exposed every day to doses of Nexium “similar to what a patient would receive” for an extended period of time, Cooke said.

Protective endothelial cells produce substances that relax the blood vessel, and create a slick “Teflon” coating inside the vessel that prevents plaques or blood clots from sticking, Cooke said.

PPIs treat heartburn by blocking acid-producing cells in the lining of the stomach, Cooke said. But researchers now suspect PPIs might also interfere with acid-producing cells elsewhere in the body.

In the case of blood vessel cells, researchers found that long-term PPI exposure impaired acid production by the lysosomes in the cells. Lysosomes typically clear waste products, but exposed to PPIs they didn’t produce enough acid to clear waste.

The waste buildup caused endothelial cells to age rapidly, Cooke said, which could hamper their ability to protect blood vessels.

“They start to convert from Teflon to something more like Velcro,” he said. “Things begin to stick.”

Another prominent class of heartburn medications, H2 blockers, did not have the same aging effect on blood vessel cells, the study found. H2 blockers include Tagamet (cimetidine), Pepcid (famotidine) and Zantac (ranitidine).

Dr. Mark Creager, president of the American Heart Association, added that a lab study like this cannot prove a direct link between PPI use and increased risk of heart attack or stroke.

“It certainly raises the question. But now the question, once raised, needs to be answered in a well-designed clinical trial, which hasn’t taken place yet,” said Creager, a professor of medicine at Harvard Medical School. “I would not advise clinicians to jump from this important basic science study to recommendations they would provide to their patients.”

Another expert said PPIs should be used with caution due to possible harms “that have nothing to do with the digestive system.”

“Much more work needs to be done before we can draw a line with confidence from this class of drugs to some of these potential side effects, but these researchers are taking an important first step,” said Dr. David Robbins, interim chief of gastroenterology at Lenox Hill Hospital, in New York City.

“Bottom line: If you take a daily PPI, which can save lives in the right scenario, check with your doctor and see if you really need it,” Robbins said.

Lifestyle adjustments — such as exercising, cutting down on alcohol or caffeine, and avoiding heavy meals just before bedtime — might also ease heartburn, Cooke added.

The findings were published in the journal Circulation Research.

Source: U.S. Department of Health and Human Services


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