Given meds for Reflux - Allergy and Side effect fear

[RadioGaGa]

I've been itching to reply to this all day, but as I was working I wasn't able to get the time this topic deserves (in work) and also have the comfort of typing such a long reply from my laptop, rather than the mobile version.

Firstly, great posts by Fishman and I agree with all his sentiments - I only want to add some of my own to try and get rid of the stigma that seems to surround these drugs... Not only on here, but on the internet in general.

I've had reflux symptoms since I was a teenager (possibly earlier). I thought it was a normal phenomenon, to be woken up in the middle of the night with a burning gullet and that it happened to everyone. I was about 18 or 19 (we'll say 18 for argument) when I finally went to the GP. I was quickly diagnosed with GORD (GERD in the US) and began Omeprazole. I have never looked back. I'm 26 in just a few weeks time, and I couldn't imagine ever coming off these drugs. My GP is of the same sentiment.

This post is comprised of both my personal and professional view of the PPIs.

Every day these drugs are handed out. Many many times per day. They're excellent for the following conditions:
* Long term reflux (e.g. GORD)
* Gastroprotection (i.e. protecting the stomach) (e.g. the patient is on steroids/NSAIDs etc)
* Eradication of H. Pylori
* Healing of stomach ulcers
* Prevention and treatment of erosivive Oesophagitis
* Treatment of upper GI bleeds
* Dyspepsia

IME, the majority of people over the age of about 50 are on them even if it's just a "when required" dose (pretty pointless - these drugs don't work instantly, there are far better 'rescue' medications for reflux, but some doctors still insist on "Take one capsule when required"). They're particularly common in those with polypharmacy going on (e.g. they're taking several+ medications).

Vitamin B12 Deficiency
Yes the PPIs can cause this - but it's not exactly a life threatening situation to be in. Vitamin B12 is absoirbed because it is removed from food by stomach acid - when you're on PPIs, if your intake isn't great, your blood levels of B12 may decrease. Simple remedy? Take a supplement. Personally, I sometimes take a supplement, although on the whole I don't bother (I'm lazy). And I'm not that worried about it. My father was started on Zantac (ranitidine) in the mid 1980s, switched to PPIs in the early 2000s. His reflux has always been a tad refractory (e.g. difficult to treat) so his maintenance dose of Omeprazole is 40mg (usual maintenance is 20mg). Again, he has had no issues whatsoever. He, like I, loves indian food - if he didn't take Omeprazole, he simply couldn't eat it (or much else!) so there's an overriding "quality of life" issue here. The benefits in his case, as for the vast majority of people taking these meds, FAR outweighs the risks they present.

My Aunt (an overweight smoker) has suffered from reflux for a few years now. A while back, my mum and her went on holiday and a mixture of all the alcohol and exotic food upset her stomach and she was being sick, with reflux, and it ruined the holiday. She saw her GP, who prescribed PPIs. They went on holiday again and there was no issue with reflux. Although being overweight and smoking are risk factors for reflux, they're also risk factors for cancer of the oesophagus. So is reflux. So let's try and reduce the risk of the latter and give her a PPI, and of course, improve her quality of life.

I read on the Patient UK Forums a few years ago a case where an anonymous gentleman posted a "story" about a "lady he worked with" having cancer of the oesophagus diagnosed (and subseqeuntly dying from it). He believed the PPIs had caused and masked the cancer. Assuming this story were true, emotions can often override sense and people look for something to blame. However, it has not been unknown for "natural, herbal remedy" seeking people to infiltrate forums and post rubbish about "Big Pharma" in order to scare people off taking drugs, and instead resort to "natural therapies". Important Point: NATURAL DOES NOT MEAN SAFE.

The gist of his story was this lady complained of headaches. After OTC ibuprofen and paracetamol did no good, her GP referred her for an MRI, where a primary was found in her oesophagus with a secondary deposit was found in the brain. She then passed away not long after, and he was convinced the PPIs (he did not say which) had caused the cancer and masked its symptoms.

1. He made no mention of her social history. Was she a smoker? Drinker? Diet? The former two being powerful risk factors for this disease, the latter less so.
2. To further "back up" his "findings", he mentioned that a "neighbours friend" or a "friends neighbour" (I can't remember which) started taking PPIs, and then three years later needed her gallbladder removed. Again, he was convinced this was caused by the PPIs.
3. PPIs could not mask a tumour obstructing the oesophagus. It could reduce the reflux caused by a tumour, but not swallowing difficulties which are a far more common symptom. PPIs have been known to mask but NOT cause cancer of the stomach. Taking PPIs is NOT a risk factor for stomach cancer, so this should NOT concern anyone - but anyone with other risk factors for stomach cancer e.g. smoking, pickled foods, red meat consumption etc should look at modifying those risk factors.

I mentioned the above because I've seen a LOT of similar scare stories on the internet without any good scientific backing. But, sadly, people will believe what they read and throw the PPIs out, suffer with the reflux and then potentially end up with oesophageal cancer caused by excess reflux! When a PPI could have prevented it! It's the same reasons some people end up suffering strokes and heart attacks, because they read negative (and in most cases, bullsh*t opinions) of non-qualified people online and don't take their medication.

I, for one, can never imagine myself stopping my PPIs. I can eat spicy food, I can eat a more varied diet and I can sleep soundly - key ingredients, IMO, to a satisfying and healthy life (maybe not the spicy part!).

Of course, it is up to the person prescribed the medication to decide whether or not they take it. The internet is a great source of information, and so long as they base their decision on sound advice, so be it. But PPIs do NOT deserve the stigma they seem to accrued in recent times. There's simply not the scientific backing for it.

Just my 2 cents

Good luck