scary news!!

Diseases & Conditions GERD & Acid Reflux
1
Today I heard on the Canadian Broadcsting Corp. (or national public radio) that esophageal cancer is the fastest-growing cancer in North America. How can that be, when the pharmaceutical companies are making billions off all those wonder drugs they're selling us? Are there that many more digestive systems out of whack these days -- I guess that's possible, considering our bad diets -- or are the drugs themselves somehow implicated?
 
Seagal
2

I heard that too. Maybe some of it is because they're able to detect and diagnose it better?

I'm amazed at the amount of people with digestive problems. Look at all the message boards about them! It's probably a combination of our busy lifestyles, stress, eating quickly or not at all, eating processed foods, taking medications (antibiotics in particular) and other things I can't even think of, that contribute to them. No wonder doctors have a hard time helping us.
 
I have no idea if the medications are a cause. They might contribute something. What starts it all in the first place though? I've had a poor digestive system since I was little and would get frequent indigestion. My friends were all okay. I was lucky to have a mom who cooked every day. I can't imagine growing up and just eating fast food and frozen dinners.
 
I wish the medical community would look for causes and not just treat symptoms. It's frustrating. Isn't it amazing after all this time, we still know so little about the human body?
 
~Niki
3
I think it probably has something to do with our modern life.........too many carbs, too many preservatives, too many chemicals, too much eating, too much drinking, too much, too much, too much.
I, too, am becoming very disenchanted with the medical community, and how it only treats with bandaids, and doesn't begin to think holisically.
What I found absolutely amazing when I went to a GI doc a few years back, was that he wasn't interested at all in what I ate. He just wanted to immediately put me on a PPI for GERD and other drugs for IBS. I get too many side-effects with the IBS drugs, so I just suffered. Then, several years later, I read that taking calcium can help people with IBS-diarrhea. I tried it, and it helped me so much. Why didn't a GI doc even tell me about something like calicum, that would be so simple to use?
I'll get off my soap box in a minute.......but this country lives horribly as far as health is concerned. It's because it's the people who want to make money off of us that are in charge of things. Our children will be lucky to get into their 20's without having type II diabetes, osteoporosis, GERD, just to name a few.
My children were raised to eat alot of veggies, fruit, fish, and other good things. They were not allowed to drink coke all the time, or eat candy. But I met very few other kids in their school who ate like that. For them it was chips, cokes, candy, french fries, etc. It's unbelieveable that this can happen in the richest country in the world.
4
Interesting discussion,
I believe there is reason to believe that our increased consumption of excess carbohydrates is responsible for this rise in esophageal cancer based on starchy carbohydrates causing acid reflux as I have discussed in my previous posts. The PPIs do not appear to decrease this risk, so esophageal damage which can lead to Barretts and esophageal cancer must involve more than just acid, like bile and digestive enzymes.

All the best,
Norm Robillard

I am a Ph.D. microbiologist and author. I am not a physician. The views I express, while research-based, are my own and should never take the place of consultations with your own physician.
 

5

Norm,

Besides the study on carbonated drinks you mention are there studies correlating the rise of carb consumption over, say the past 20 years, with an increase in digestive problems, including esophogeal cancers? 

I guess I sound a bit shrill on the subject of PPIs. I think there is a case to be made for the possibility of long-term use increasing the risk of stomach cancer because of abnormally high levels of gastrin. The sad thing is that so many people are taking PPIs out of fear, and thinking they are going to be protected from Barrett's and worse.  I have a friend who has been on Prilosec for nine years and loves it, says she can eat anthing she wants.  She's also overweight and has landed in the ER a couple of times because she was unable to swallow her own saliva.

What is scary for all of us is that so many doctors seem to be passing PPIs out freely, without warning patients of possible long-term risks, and without properly testing to see whether the drugs are appropriate for the condition.  Just a wild guess and a prescription good for a year.  Arrgh.

Seagal


Post Edited By Moderator (~Jennifer~) : 3/13/2006 12:15:11 PM (GMT-7)

6
Seagal
 
Your friend who has been on PPI's for so long. Have they done any other testing on her? How much overwieght and how old is she? The reason I ask is that just seems so long for PPI's and to use those as an excuse of being able to eat what she wants. I think dietary changes need to be made. You cannot just put a blanket over the problem.
 
That is just my opinion.
 
Marsha
7
I worry about taking PPI's but don't think my healthy diet is going to erase the problem. So what will? confused I still have breakthrough symptoms too with the tablets.
8
It's important to note that studies involving the first PPI, omeprazole, are continuing after 21 years. None of which have definitively shown any long-term side effects.
9
Of course ...

(1.) Laine L, Ahnen D, McClain C, Solcia E, Walsh JH. Review article: potential gastrointestinal effects of long-term acid suppression with proton pump inhibitors. Aliment Pharmacol Ther 2000; 14:651-668.

(2.) Garnett WR. Considerations for long-term use of proton-pump inhibitors. Am J Health Syst Pharm 1998; 55:2268-2279.

(3.) Freston JW. Long-term acid control and proton pump inhibitors: interactions and safety issues in perspective. Am J Gastroenterol 1997; 92(4 Suppl):51S-57S.

(4.) Thjodleifsson B, Rindi G, Fiocca R, et al. A randomized double-blind trial of the efficacy and safety of 10 or 20 mg rabeprazole compared with 20 mg omeprazole in the maintenance of gastro-oesophageal reflux disease over 5 years. Aliment Pharmacol Ther 2003; 17:343-351.

(5.) Garcia Rodriguez LA, Ruigomez A. Gastric acid, acid-suppressing drugs, and bacterial gastroenteritis: how much of a risk? Epidemiology 1997; 8:571-574.

(5.) Proton pump inhibitor relabeling for cancer risk not warranted; long-term studies recommended. FDC Rep 1996; 58(Nov 11):T&G:1-2.

(6.) Management of gastroesophageal reflux disease (GERD). Ann Arbor, Mich: University of Michigan Health System; last updated 2002 March. Available at: cme.med.umich.edu/iCME/gerd/default.asp. Accessed on March 16, 2004.

(7.) DeVault KR, Castell DO. Updated guidelines for the diagnosis and treatment of gastroesophageal reflux disease. The Practice Parameters Committee of the American College of Gastroenterology. Am J Gastroenterol 1999; 94:1434-1442.

** Of particular note is reference #5
10
A published article from the Journal of Family Practice ....

http://www.jfponline.com/Pages.asp?AID=1775&UID=
11
ckg,
What about:

Laheij Rj, Sturkenboom MC, Hassing RJ, Dieleman J, Stricker BH, Jansen JB. Risk of community-acquired pneumonia and the use of gastric acid suppressive drugs. JAMA 2004 Oct 27; 292 (16):1955-60.

This study of more than 364,000 people showed that people taking PPIs for prolonged periods had double the risk of pneumonia. The reason argued by the authors is that blocking stomach acid allows intestinal bacteria to reflux (yes reflux still occurs on PPIs) into the esophagus and lungs where they are capable of causing infection.

That's nothing to sneeze at (excuse the pun).

Norm Robillard

I am a Ph.D. microbiologist and author. I am not a physician. The views I express, while research-based, are my own and should never take the place of consultations with your own physician.
 

12
Interesting study ... certainly the Scandanavian countries are far more adept than the United States at studying these types of occurences. Especially -- in trials of Pregnant women.

However -- the authors did note that there a lot of confounding variables and that this was not a randomized, controlled trial. Additionally - the nature of the trial was observational and (more importantly) the trial allowed for "probably" pneumonia as well as altering definitions of the organism.

RCT's, as you well know, are the body of literature that should have an influence on prescribing behaviour by physicians. Additionally -- the benefits afforded patients on PPIs are still far beyond the risk:benefit ratio.
13

Thank you for posting these references. I have just read the first one cited, which says PPIs are generally considered safe for long-term treatment, but also states: "There is no evidence that acid suppression therapy with PPIs causes regression of Barrett's esophagus or prevents progression to adenocarcinoma of the esophagus."  In light of this, and in view of the fact that PPIs treat symptoms, do not cure, and are of limited efficacy, it is difficult for us poor patients to evaluate risks versus benefits.  The article does warn that PPIs may inhibit absorption of certain drugs, as well as B-12 and iron, which sounds like a bit of a risk to me. 

Interesting that the article mentions that the most frequent adverse effects are "headache, diarrhea, abdominal pain and nausea."  (Of course the drug companies also acknowledge a very long list of possible side effects, much more serious.)  Just like the side effects once listed for Propulsid -- headache, diarrhea, abdominal pain, constipation and nausea. The FDA approved Propulsid in 1993, apparently believing that it carried only minor risks. Presumably that drug had been the subject of a number of scientific trials. It wasn't recalled until 2000.

It would be interesting to know where the funding is coming from for research on GERD-related drugs. (No funding source is given for the article in question.)  It would also be interesting to find a few more studies on non-drug alternatives for GERD therapy. And studies on the cause of the condition.  But who would fund them? Not the rich drug companies, unfortunately.

Seagal

14
What about the effects of the otc drugs like zantac that work differently than the ppis? And why do doctors act so bewildered about acid reflux? Even the so-called specialist who charge $2500.00 to look through the scope for 5 minutes!! This board has helped me to learn so much more than either of my doctors. They seem perplexed by it and then write a prescription! I have been given every ppi made and still after almost 3 years have this daily problem. I know it was caused by overuse of antibiotics. Does anyone know anything about why the antibiotics cause this?

Also, are drugs like zantac safe long term...and I mean taking the maximum amount every single day!
15
I GUESS THIS MEANS ALL PEOPLE WITH GERD LIKE ARE WELL SCREWED..
 
Nahh dont trip out about studys like this folks blown up
16
I don't think GERD is a disease...I think it is a symptom.