Roughly 20 percent of Americans suffer from frequent episodes of acid reflux.
Acid blockers are a great way to help ease the symptoms of heartburn. However some of the newer and stronger acid-reducing medicines appear to increase the risks of bone disease, fractures, and intestinal infections.
Listen in as Tim Koch, MD discusses the risks of long-term use of acid-reducing medications, and other options to ease acid reflux symptoms.
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Risks of Long-Term Use of Acid-Reducing Medications
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Learn more about Tim Koch, MD
Tim Koch, MD
Dr. Tim Koch graduated from the University of Chicago Pritzker School of Medicine in 1980. He works in Washington, DC and specializes in Gastroenterology. Dr. Koch is affiliated with Medstar Washington Hospital Center.Learn more about Tim Koch, MD
Transcription:
Risks of Long-Term Use of Acid-Reducing Medications
Melanie Cole (Host): Although medications for GERD or gastroesophageal reflux disease are very popular and widely prescribed, the safety of some types have been called into question. Are these meds safe for long-term use? Are some more effective and safer than others? My guest today is Dr. Tim Koch. He's a gastroenterologist at Medstar Washington Hospital Center. Welcome to the show, Dr. Koch. First, tell us: what is GERD?
Dr. Tim Koch (Guest): When we're referring to GERD, we're referring to people who have chronic acid reflux or heartburn and because of their chronic reflux or acid heartburn, they will develop problems with the food pipe.
Melanie: So, what's the standard course of treatment, Dr. Koch, that people are doing all over the country? Tell us a little bit about treatment for GERD.
Dr. Koch: Unfortunately, frequent reflux of acid is very common in the United States. Up to 20% of people in the United States have frequent episodes, or they do have acid refluxing up to the esophagus. When they see their physicians, often they're asked about simple measures such as elevating the head of the bed; such as avoiding specific foods that may bother them, such as citrus fruit, tomato-based products. In many individuals, however, this is not enough and they can buy over the counter medications such as cimetidine, such as famotidine, and, in some people, these are helpful but for the majority of people, it's still not effective. When they see their doctors, they'll then speak with them about the possibility of using the newer agents, so-called proton pump inhibitors, and it's the proton pump inhibitors which have more recently given rise to the question of, "Are they safe in the long-term use?"
Melanie: Are there complications to untreated GERD, Dr. Koch?
Dr. Koch: People with untreated GERD can develop damage to the food pipe and that damage can present with trouble swallowing; with vomiting. This is due to scarring of the food pipe. It's been known for quite some time that individuals with chronic GERD may have an increased risk of developing a precancerous type of lesion called Barrett's esophagus, and in studies from around the world, the question has been raised whether chronic GERD is a risk factor for the development of cancer of the food pipe.
Melanie: So then, let's discuss those medications for what can be silent, right? GERD doesn't necessarily mean something that you feel--that heartburn feeling. It's not always like that, is it?
Dr. Koch: People can present with other symptoms and then, we need to be thinking about whether this is due to GERD. Other types of symptoms can include earache, sore throat, nasal congestion, atypical feelings in the chest--chest pain or chest pressure --and some people may just present with a morning cough.
Melanie: So then, if they are taking a proton pump inhibitor, which there are many, what do you tell them when they ask you about the safety of these and long-term use?
Dr. Koch: For just a very brief overview, we've heard about the question of long-term safety for a number of years from studies in which we reviewed the question of whether it increases action in the gut, whether or not it increases the risk of having bone loss. I think most patients now are asking us about long-term use because they've seen recent reports that long-term use might increase the risk of dementia, or might increase the risk of chronic kidney disease. When we see patients on long-term use, the first thing we try to do is find out exactly how much they are using. Are they using it every day? If they're using multiple doses a day, this might be a higher risk. If they're using it for many years, it might be a higher risk. If we're not exactly sure why they're taking the medication, then this is something which also I think is important that may indicate that over time, they may be at higher risk. The first proton pump inhibitor, which was named Prilosec, was developed by Astra Sweden in the late 1970's. Prilosec was approved by the Food and Drug Administration in the United States in 1990 and was initially approved for treating ulcer disease. People then thought about whether or not this would be a good treatment for acid reflux or heartburn and Dr. Walter Hogan at the medical college in Wisconsin, in Milwaukee, started talking with his colleagues about whether or not they could start Prilosec for treatment of chronic acid reflux. When Prilosec was originally approved, it was approved for short-term use of only a few weeks because of concern in laboratory rodents, especially rats, that they might develop a type of tumor in the stomach with long-term use. When these tested tumors were not found in humans, people then started using proton pump inhibitors, such as Prilosec, for more long-term use and that's when it was found that in people with severe chronic heartburn and reflux symptoms, that the use of Prilosec was extremely helpful.
Melanie: So, doctor, people hear about GERD from the media and from commercials. What is the role of hiatal hernia and gastroesophageal reflux?
Dr. Koch: It's been known for quite some time that there's a relationship that a hiatal hernia, in which the stomach moving up into the chest can cause irritation of the esophagus--the food pipe—and this has been known from studies where the surgeon repaired the hiatal hernia and people's problems with GERD disappeared. The most convincing studies have been people with lung problems such as chronic asthma, chronic cough or hoarseness in the morning and with repair of the hiatal hernia, these symptoms have gone away.
Melanie: Would you know someone had a hiatal hernia? Do you have to do endoscopy?
Dr. Koch: There are several ways to take a look at the actual food pipe and endoscopy is one of the ways in which a hiatal hernia can be discovered. Hiatal hernia can also be seen on an x-ray where they swallow some white chalky barium material and take a look at the food pipe.
Melanie: If people want to contribute to their own treatment without necessarily resorting to those PPIs, what do you tell them are some lifestyle modifications - things they can do to help with GERD?
Dr. Koch: This is, of course, something that's been looked at and thought about for many years. We generally don't' think that just elevation at the head of the bed, avoiding eating for three hours before bedtime, avoiding specific foods such as citrus fruits or avoiding tomatoes is sufficient and, in many people, we do try to make sure that if they're smoking, that they stop smoking and if they're overweight, are they able to lose some weight. These things may be helpful for reducing the episodes of GERD.
Melanie: And so then, if you were to tell people your best advice, what would you want them to know about GERD and the possibility of PPIs and even the role of hiatal hernia in possibly helping it?
Dr. Koch: I think the main message here is that if you've been taking these types of medications called
“PPIs” for many years; you've been using more than one dose a day; if you're not really sure why your doctor suggested you use this medication, then you need to ask your doctor about re-evaluating the situation. There are several ways this re-evaluation has been done. One way is by actually looking at the food pipe to see if there's been damage from chronic acid reflux. Another way, which can be helpful, is by performing a specialized study of the swallowing of the food pipe and the strength of contractions of the food pipe. This type of study often suggests that there are other treatments available for the reason that the patient has been taking, or the individual has been taking, one of these PPIs.
Melanie: Thank you so much, Dr. Koch. It's really great information and so important for the public to hear. You're listening to Medical Intel with Medstar Washington Hospital Center. For more information, you can go medstarwashington.org. That's medstarwashington.org. This is Melanie Cole. Thanks so much for listening.
Risks of Long-Term Use of Acid-Reducing Medications
Melanie Cole (Host): Although medications for GERD or gastroesophageal reflux disease are very popular and widely prescribed, the safety of some types have been called into question. Are these meds safe for long-term use? Are some more effective and safer than others? My guest today is Dr. Tim Koch. He's a gastroenterologist at Medstar Washington Hospital Center. Welcome to the show, Dr. Koch. First, tell us: what is GERD?
Dr. Tim Koch (Guest): When we're referring to GERD, we're referring to people who have chronic acid reflux or heartburn and because of their chronic reflux or acid heartburn, they will develop problems with the food pipe.
Melanie: So, what's the standard course of treatment, Dr. Koch, that people are doing all over the country? Tell us a little bit about treatment for GERD.
Dr. Koch: Unfortunately, frequent reflux of acid is very common in the United States. Up to 20% of people in the United States have frequent episodes, or they do have acid refluxing up to the esophagus. When they see their physicians, often they're asked about simple measures such as elevating the head of the bed; such as avoiding specific foods that may bother them, such as citrus fruit, tomato-based products. In many individuals, however, this is not enough and they can buy over the counter medications such as cimetidine, such as famotidine, and, in some people, these are helpful but for the majority of people, it's still not effective. When they see their doctors, they'll then speak with them about the possibility of using the newer agents, so-called proton pump inhibitors, and it's the proton pump inhibitors which have more recently given rise to the question of, "Are they safe in the long-term use?"
Melanie: Are there complications to untreated GERD, Dr. Koch?
Dr. Koch: People with untreated GERD can develop damage to the food pipe and that damage can present with trouble swallowing; with vomiting. This is due to scarring of the food pipe. It's been known for quite some time that individuals with chronic GERD may have an increased risk of developing a precancerous type of lesion called Barrett's esophagus, and in studies from around the world, the question has been raised whether chronic GERD is a risk factor for the development of cancer of the food pipe.
Melanie: So then, let's discuss those medications for what can be silent, right? GERD doesn't necessarily mean something that you feel--that heartburn feeling. It's not always like that, is it?
Dr. Koch: People can present with other symptoms and then, we need to be thinking about whether this is due to GERD. Other types of symptoms can include earache, sore throat, nasal congestion, atypical feelings in the chest--chest pain or chest pressure --and some people may just present with a morning cough.
Melanie: So then, if they are taking a proton pump inhibitor, which there are many, what do you tell them when they ask you about the safety of these and long-term use?
Dr. Koch: For just a very brief overview, we've heard about the question of long-term safety for a number of years from studies in which we reviewed the question of whether it increases action in the gut, whether or not it increases the risk of having bone loss. I think most patients now are asking us about long-term use because they've seen recent reports that long-term use might increase the risk of dementia, or might increase the risk of chronic kidney disease. When we see patients on long-term use, the first thing we try to do is find out exactly how much they are using. Are they using it every day? If they're using multiple doses a day, this might be a higher risk. If they're using it for many years, it might be a higher risk. If we're not exactly sure why they're taking the medication, then this is something which also I think is important that may indicate that over time, they may be at higher risk. The first proton pump inhibitor, which was named Prilosec, was developed by Astra Sweden in the late 1970's. Prilosec was approved by the Food and Drug Administration in the United States in 1990 and was initially approved for treating ulcer disease. People then thought about whether or not this would be a good treatment for acid reflux or heartburn and Dr. Walter Hogan at the medical college in Wisconsin, in Milwaukee, started talking with his colleagues about whether or not they could start Prilosec for treatment of chronic acid reflux. When Prilosec was originally approved, it was approved for short-term use of only a few weeks because of concern in laboratory rodents, especially rats, that they might develop a type of tumor in the stomach with long-term use. When these tested tumors were not found in humans, people then started using proton pump inhibitors, such as Prilosec, for more long-term use and that's when it was found that in people with severe chronic heartburn and reflux symptoms, that the use of Prilosec was extremely helpful.
Melanie: So, doctor, people hear about GERD from the media and from commercials. What is the role of hiatal hernia and gastroesophageal reflux?
Dr. Koch: It's been known for quite some time that there's a relationship that a hiatal hernia, in which the stomach moving up into the chest can cause irritation of the esophagus--the food pipe—and this has been known from studies where the surgeon repaired the hiatal hernia and people's problems with GERD disappeared. The most convincing studies have been people with lung problems such as chronic asthma, chronic cough or hoarseness in the morning and with repair of the hiatal hernia, these symptoms have gone away.
Melanie: Would you know someone had a hiatal hernia? Do you have to do endoscopy?
Dr. Koch: There are several ways to take a look at the actual food pipe and endoscopy is one of the ways in which a hiatal hernia can be discovered. Hiatal hernia can also be seen on an x-ray where they swallow some white chalky barium material and take a look at the food pipe.
Melanie: If people want to contribute to their own treatment without necessarily resorting to those PPIs, what do you tell them are some lifestyle modifications - things they can do to help with GERD?
Dr. Koch: This is, of course, something that's been looked at and thought about for many years. We generally don't' think that just elevation at the head of the bed, avoiding eating for three hours before bedtime, avoiding specific foods such as citrus fruits or avoiding tomatoes is sufficient and, in many people, we do try to make sure that if they're smoking, that they stop smoking and if they're overweight, are they able to lose some weight. These things may be helpful for reducing the episodes of GERD.
Melanie: And so then, if you were to tell people your best advice, what would you want them to know about GERD and the possibility of PPIs and even the role of hiatal hernia in possibly helping it?
Dr. Koch: I think the main message here is that if you've been taking these types of medications called
“PPIs” for many years; you've been using more than one dose a day; if you're not really sure why your doctor suggested you use this medication, then you need to ask your doctor about re-evaluating the situation. There are several ways this re-evaluation has been done. One way is by actually looking at the food pipe to see if there's been damage from chronic acid reflux. Another way, which can be helpful, is by performing a specialized study of the swallowing of the food pipe and the strength of contractions of the food pipe. This type of study often suggests that there are other treatments available for the reason that the patient has been taking, or the individual has been taking, one of these PPIs.
Melanie: Thank you so much, Dr. Koch. It's really great information and so important for the public to hear. You're listening to Medical Intel with Medstar Washington Hospital Center. For more information, you can go medstarwashington.org. That's medstarwashington.org. This is Melanie Cole. Thanks so much for listening.