Side effects

Do you, like me, suffer from excess stomach acid? If so, you probably take one of those anti-acid or anti-reflux drugs, which are very effective in reducing the ill effects of those acids and reflux. Karen Weintraub reports in Scientific American,

Over-the-counter packages of Nexium, Prevacid and Prilosec tell you to take the pills—known to doctors as proton-pump inhibitors, or PPIs—for just two weeks at a time unless otherwise directed by a physician. Yet drugs of this best-selling class prevent heartburn and ease related ailments so well that patients—particularly those who suffer from a condition called GERD (gastroesophageal reflux disease)—are often advised to take the medications for years. By decreasing acid production in the stomach, the agents prevent the caustic liquid from backing up—or refluxing—into the esophagus, where it can cause pain and can damage the food tube's delicate lining.

In recent years, though, safety questions have been raised about prolonged use of the blockbuster drugs. (The medications appear to be safe when taken for a short period, as directed.) Some studies, for example, have linked continuous treatment with proton-pump inhibitors to serious infections caused by the bacterium Clostridium difficile. Presumably something about lowering the acid environment of the stomach allows the pathogens to survive when they otherwise might not. Other investigations suggest long-term changes in the stomach's acid content can lead to improper absorption of several vitamins—such as B12—and minerals, triggering bone loss, among other ill effects.

Perhaps the biggest surprise came last year when two studies linked the regular use of proton-pump inhibitors to conditions that were seemingly unrelated to the acid levels of the stomach. One of the studies, published in JAMA Neurology, found that the drugs increased the risk of developing dementia, including Alzheimer's disease; the other, published in JAMA Internal Medicine, suggested a greater risk of kidney problems.

...Without conclusive data, physicians and patients have to balance the need to prevent the ill effects of excess stomach acid and reflux with the desire to avoid potentially serious—if theoretical—side effects from long-term use of PPIs.

...Whenever one of Staller's patients at Mass General says he or she wants to stop taking a PPI, he likes to perform a simple test. He has the person stop taking the medication for a week and substitutes Tagamet or another H2 blocker. (Stopping a PPI cold turkey, without adding another drug, typically causes a rebound effect, pushing the stomach to produce even more acid than it otherwise would.) He also recommends cutting back on acidic and spicy food for the length of the test. Then he sees if the patient is still bothered by heartburn at the end of a week, especially during the day, when gravity should help prevent acid from rising up into the throat. The persistence of heartburn indicates the presence of a more severe problem, Staller says. And thus, the benefit of taking a daily PPI outweighs the risks in such cases.

The calculus, obviously, is different for everyone. For Vicki Scott Burns, a children's book author in Bolton, Mass., PPIs are “the lesser of two evils.” She says her quality of life is vastly better on the drugs. Others might reach an alternative conclusion. In the end, Staller and other health experts advise patients and their physicians to gather and evaluate as much information as possible before making a decision—and to be prepared to change course if new evidence comes to light.

Read more here.