Risks of some acid-reducing drugs may outweigh benefits

More than 113 million prescriptions are written every year for proton pump inhibitors, drugs such as Prilosec or Nexium that Americans take to treat ulcers or other problems affecting the stomach or esophagus. But more than half the time these acid-reducing drugs are overprescribed for less serious heartburn or indigestion, according to research cited in tomorrow's Archives of Internal Medicine.

The drugs do relieve stomach discomfort, but people who take them may be more likely to encounter other problems such as fractures or certain infections, three new studies say.

"For most patients the adverse effects of [proton pump inhibitors] outweigh the benefits," Dr. Mitchell Katz of the San Francisco Department of Public Health writes in an editorial.

Dr. JoAnn E. Manson of Brigham and Women's Hospital was part of a team that looked at the acid-suppressing drugs and broken bones related to osteoporosis among more than 161,000 older women enrolled in the the Women's Health Initiative. After eight years, women who took the drugs were no more likely to break their hips than women who didn't take the drugs. But they did have a 47 percent increased risk of spine fractures, a 26 percent increased risk of forearm or wrist fractures, and a 25 percent increased risk of other fractures. The authors advise doctors to periodically evaluate whether their patients should continue to take the drugs.

Two other studies consider whether proton pump inhibitors are linked to infections with Clostridium difficile, the leading cause of hospital-acquired diarrhea. Dr. Michael D. Howell of Beth Israel Deaconess Medical Center led a study that analyzed more than 100,000 admissions to the hospital. Patients who took proton pump inhibitors daily were 74 percent more likely than other patients to develop a C. difficile infection in the hospital, with the risk climbing higher with greater use of the drug.

In the other study, Dr. Amy Linsky of Boston Medical Center and her colleagues report on patients whose C. difficile infections recurred within 90 days. Among more than 1,100 patients treated at the New England Veterans Healthcare System, those who used proton pump inhibitors had a 42 percent higher risk of recurrence than patients who did not take the drugs.

Katz, who wrote the editorial, says doctors may want to ask their patient to try other ways to treat indigestion, such as eating smaller meals, losing weight, quitting smoking, reducing stress, or raising the heads of their beds at night. Or none of those. "Many cases ... resolve on their own," he writes.

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