Heartburn Drugs May Contribute to the Problem

July 2009 study suggests proton pump inhibitors could aggravate acid trouble in some

Please...don't tell me Kevin Tredeau ("Natural Cures They Don't Want You to Know"--infomercial bookseller) was right.  (Even though he might have been.)

A new study in the July issue of Gastroenterology suggests that popular drugs commonly used to treat heartburn and acid reflux may actually cause heartburn.

The researchers found that treatment with a proton pump inhibitor (PPI) actually produced heartburn,acid reflux and indigestion in healthy volunteers who took the medication for eight weeks.

Do you think pharmaceutical companies will be disclosing that in their commericals?  (Probably will have to)

The following are classified as proton pump inhibitors:

omeprazole (Prilosec),
lansoprazole (Prevacid),                                                    rabeprazole (Aciphex),
pantoprazole (Protonix),
esomeprazole (Nexium), and
Zegarid, a rapid release form of omeprazole.

Although the findings don't necessarily mean that these drugs don't have a valid place in the gastrointestinal treatment, they do strongly suggest that overprescribing may be causing harm, the study authors said.

Naturally, the research authors are quick to point out that 'beyond any doubt that subjects with reflux disease benefit from and need treatment with acid suppressive drugs,' however add that 'it is equally beyond doubt that PPIs are prescribed more or less uncritically for a wide variety of symptoms where the initial effect of the drug is doubtful.'

Imagine that.

The researchers summarized that their findings indicate that the liberal prescribing of PPIs to patients for uncertain conditions is likely to create the disease the drugs are designed to treat, thus risk developing a true need for continued therapy.  They conclude that their findings challenge the very liberal prescribing of these drugs, and this study should lead to careful consideration about possible changes in prescribing habits.

According to an accompanying editorial in the journal, about 5 percent of the developed world's population now uses PPIs.

And more people are using the drugs long-term, although this should only occur when a person has severe gastroesophageal reflux disease (GERD) or to prevent problems in people taking nonsteroidal anti-inflammatory medications, such as aspirin, which can be hard on the stomach, the researchers said.

But according to the study authors, about one-third of patients who take PPIs renew their prescriptions without one of these indications. And the editorial stated that the drugs are being prescribed without hard evidence that acid is involved with the problem. PPIs work by reducing acid production.

For this study, 120 healthy people were randomly assigned to receive 12 weeks of a placebo or eight weeks of Nexium (esomeprazole, 40 milligrams a day), followed by four weeks of placebo.

Forty-four percent of individuals receiving the PPI reported acid-related symptoms after stopping the medication, compared with 15 percent in the placebo group.

The study authors speculated that the post-treatment effect comes from an acid "rebound" after the period of inhibition. If this does turn out to be the case, the process could end up causing dependency on PPIs, the researchers said.

Being a typical researcher, one of the investigators admittend that patients need to be informed about the potential effects of the rebound acid hypersecretion and the symptoms it can cause when therapy is initiated, but also stated that more research into the phenomenon is needed.

The goal of this outcome would be to make patients and their doctors aware of this phenomenon so that they could be prepared for it if it occurs.  It would also help in patient management use of the drugs.  

A spokesman for AstraZeneca, which makes Nexium, said: "This study was conducted with healthy volunteers, and the authors acknowledge that they can't be sure that the conclusion can be carried over to patients who have started PPI therapy because of dyspeptic symptoms. A previous systematic review of rebound acid hypersecretion after discontinuation of PPIs concludes that there is no strong evidence for a clinically relevant increased acid production after withdrawal of PPI therapy."

Spokesman or spin doctor? 

Trust your gut.