- People who use certain drugs for chronic heartburn may be at
increased risk of developing kidney disease, a new study suggests.
The
research is the latest to highlight potential risks from drugs called
proton pump inhibitors (PPIs). PPIs include prescription and
over-the-counter drugs, such as Prilosec, Prevacid and Nexium.
But
prolonged use of PPIs has been linked to certain nutrient deficiencies
and bone-density loss. According to the U.S. Food and Drug
Administration, bone fractures are considered a safety concern when
people use PPIs for a year or more.
More recently, research has
hinted at additional hazards. Last year, for example, a study tied the
medications to a slight increase in heart attack risk.
However, neither that study nor this new one prove that PPIs are directly to blame for these problems.
"I
cannot say for certain that this is cause-and-effect," said Dr. Ziyad
Al-Aly, one of the researchers on the current study and a kidney
specialist with the Veterans Affairs St. Louis Health Care System.
His
team found that PPI users were more likely than people on other
heartburn medications to develop chronic kidney disease or kidney
failure over five years.
The researchers did try to rule out other
possible explanations, such as PPI users being older or in poorer
health. But, Al-Aly said, there could still be other factors that
account for the higher kidney risk.
Despite the uncertainty,
Al-Aly said the findings underscore an important point: People should
use PPIs only when it's medically necessary, and for the shortest time
possible.
"I think people see these medications at the drug store
and assume they're completely safe," Al-Aly said. "But there's growing
evidence they're not as safe as we've thought."
A doctor who specializes in treating chronic heartburn agreed.
A
key problem is that many people take PPIs when they're unnecessary, or
take them for too long, said Dr. F. Paul Buckley. He is surgical
director of the Heartburn & Acid Reflux Center at the Scott &
White Clinic, in Round Rock, Texas.
For occasional heartburn, PPIs are not appropriate -- or even helpful, Buckley said.
So,
he said, people should first make sure they have true gastroesophageal
reflux disease (GERD) -- where stomach acids chronically rise up into
the esophagus because of weakness in a muscle between the esophagus and
stomach.
About 20 percent of Americans have been diagnosed with
GERD, according to the U.S. National Institute of Diabetes and Digestive
and Kidney Diseases. Heartburn is a symptom, and people who suffer
heartburn more than twice a week may have GERD, the institute says.
PPIs
are powerful stomach acid suppressors, Buckley said, and they do work
well for people with more-severe reflux. If someone has inflammation in
the esophagus or an ulcer, for instance, PPIs can allow those problems
to heal, he explained.
But diet and other lifestyle changes are
also vital, according to Buckley. And after a patient has used a PPI for
a month or so, it's often possible to "step down" to an H2-blocker and
lifestyle changes.
When people are "severe refluxers," and can't
drop their PPI, Buckley added, surgery to address the underlying problem
might be an option.
The new study findings are based on medical
records from over 173,000 VA patients who were prescribed a PPI and over
20,000 other patients prescribed another class of heartburn drug called
H2-blockers. Those include brands like Zantac, Pepcid and Tagamet,
which are also available over-the-counter.
Over five years, 15
percent of PPI users were diagnosed with chronic kidney disease, versus
11 percent of those on H2-blockers. After the researchers weighed other
factors, PPI users still had a 28 percent greater risk.
source--.usnews
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