Labels: acid reflux, GERD

Stomach acid may only be part of the problem when it comes to esophagus injury related to gastroesophageal reflux disease (GERD). A new study suggests that an immune system response may be the real culprit behind reflux esophagitis.

Researchers say it's been assumed that reflux esophagitis develops when cells in the lining of the esophagus become burned and damaged by stomach acid backing up into the esophagus.

But in a rat model of GERD, researchers found that this acid reflux didn't directly damage the lining of the esophagus. Instead, the acid triggered the release of chemicals called cytokines that attract inflammatory immune cells to the area, which were responsible for the real damage.

If further studies in humans confirm these results, researchers say new GERD treatments that target this immune response may be needed to effectively manage the disease.

"Currently, we treat GERD by giving medications to prevent the stomach from making acid," says Rhonda Souza, MD, associate professor of internal medicine at the University of Texas Southwestern Medical Center, in a news release. She says "maybe we should create medications that would prevent these cytokines from attracting inflammatory cells to the esophagus and starting the injury in the first place."

In the study, published in Gastroenterology, researchers created GERD in rats by performing an operation to connect the duodenum (first section of the small intestine) to the esophagus, allowing stomach acid and bile to enter the esophagus.

The results showed damage to the lining of the esophagus did not occur immediately after exposure to the stomach acids. It happened weeks later.

"That doesn't make sense if GERD is really the result of an acid burn," says researcher Stuart Spechler, MD, professor of internal medicine at UT Southwestern, in the news release. "Chemical injuries develop immediately. If you spill battery acid on your hand, you don't have to wait a month to see the damage."

Within three days after the operation, researchers found no damage to the cells on the surface layer of the esophagus, but they found inflammatory cells in the deeper layers. Those inflammatory cells rose to the surface three weeks later after the initial stomach acid exposure.

WebMD

Labels: acid reflux, GERD

Proton pump inhibitors are highly effective treatments for acid reflux symptoms, but taking prescription-strength dosages of the drugs for just a few months can lead to dependency, new research suggests.

Healthy adults in the study with no history of acid reflux symptoms -- such as chronic heartburn, indigestion, or acid regurgitation -- developed such symptoms when they stopped taking the drugs after eight weeks of treatment.

The findings provide the best evidence yet that withdrawal from acid-blocking proton pump inhibitor (PPI) therapy is associated with a clinically meaningful increase in acid production above pre-treatment levels, researchers say.

PPIs like Aciphex, Prilosec, Prevacid, Nexium, and Protonix are among the most widely used prescription medications in the world. By one estimate, 5% of adults in developed countries take the acid-reducing drugs.

“We have known for years that long-term treatment with PPIs induces a temporary increase in the secretion of acid, but the thinking has been that this probably wasn’t clinically relevant,” lead researcher Christina Reimer, MD, of Copenhagen University tells WebMD.

PPI-Related Rebound

Reimer and colleagues recruited 120 healthy adults with no history of acid reflux disease for the study.

Half the study participants were treated with daily 40 milligram doses of the PPI Nexium for eight weeks, followed by four weeks on a placebo. The rest took a placebo pill throughout the 12-week trial.

Each week, the participants completed a standardized questionnaire designed to rate the severity of gastrointestinal (GI) symptoms.

Although symptoms were similar in the two treatment groups at the start of the study, a big difference in symptoms was seen in the weeks after the active treatment group stopped taking the PPI.

In the PPI group, 44% reported at least one acid-related symptom in weeks nine through 12, compared to 15% of the placebo group.

By week 12, when the PPI group had been off active treatment for four weeks, about 21% reported symptoms of heartburn, indigestion, or acid regurgitation, compared to slightly less than 2% of those who never took a PPI.

The study appears in the July issue of the journal Gastroenterology.

Calls to study participants three months after PPI treatment was stopped confirmed that these symptoms had resolved, Reimer says.

“We don’t know how long this rebound effect lasts, but we can say that it is somewhere between four weeks and three months,” she says.

This rebound is theorized to the result of an overproduction of the stomach acid-stimulating hormone gastrin in response to PPI-related acid suppression.

When the medication is stopped, the extra gastrin in the blood signals the stomach to work overtime to produce acid. When gastrin levels return to normal, acid secretion slows, writes Reimer.

“PPIs Over-Prescribed”

Reimer says the phenomenon, known medically as rebound acid hypersecretion, is not likely to occur in people who take the over-the-counter version of the PPI Prilosec for short periods.

She adds that the benefits of PPI treatment still appear to far outweigh the risks for patients with established acid reflux disease.

“Most patients with acid reflux disease need an acid-suppressing drug and they should not be concerned about this,” she says. “But millions of people are prescribed these drugs for uncertain indications and in these patients we run the risk of inducing the symptoms that these drugs are used to treat.”

PPI researcher Kenneth McColl, MD, of the University of Glasgow, tells WebMD that the drugs are now widely prescribed for a host of upper GI complaints even though there is little evidence that they are effective for these uses.

“It is clear that doctors need to be more selective in prescribing these drugs,” he says. “They should not be given to patients with upper GI symptoms on the off chance that the symptoms are acid related.”

In response to the study, a spokesman for AstraZeneca Pharmaceuticals, which markets Prilosec and Nexium, questioned the study design and its relevance to patients with acid reflux symptoms.

“This study was conducted in 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,” Blair Hains tells WebMD.

Hains cited a 2007 review of research examining rebound acid hypersecretion, which concluded that there was not strong evidence that withdrawal from PPIs is associated with a clinically relevant increase in acid production.

Calls to Takeda Pharmaceuticals, which manufacturers Prevacid, were not returned by publication time.

webmd

Labels: acid reflux

We've all gotten them at one time or another: gifts of food that were disappointing or misguided, even comical. Sometimes it isn't the gift itself that doesn't work so much as the match between the gift and the recipient.

For example, I was the goofball who, with all the best of intentions, gave a Starbucks gift card to a music teacher at my daughter's school. It didn't occur to me that he might be a Mormon (see No. 7 in the list below).

Here's another example: I was once given dark chocolate as a gift, when anyone who knows me well knows that I prefer milk chocolate. (The giver in this instance happened to be my mother.)

So, with some personal experience and some tongue-in-cheek reflections on gifts from Christmases past, here is my list of 13 food gifts NOT to give:

1. Don't give sugar-free candies or chocolates to someone with IBS (irritable bowel syndrome) or other intestinal issues. The sugar replacement often used in these products is maltitol, which is only partially digested and absorbed. The part that isn't digested tends to ferment in the intestinal tract and attract water. To someone with diarrhea -predominant IBS, having a few pieces of these sugar-free goodies can cause some "intestinal issues". (As someone who has IBS, I can speak from sad experience.) We'll leave it at that.
2. Pay attention that you don't give tea with special properties to someone whom it might offend. The Republic of Tea, for example, makes "Get Lost" tea, described as "herb tea for weight control"; "Get it Going" tea (for regularity); and "Get Gorgeous" tea (for clear skin).
3. Be sure you don't give alcohol to someone who doesn't (or shouldn't) drink. Even if someone has consumed alcohol in the past, they may now be avoiding it for a number of possible reasons.
4. Don't give those tins of stale popcorn to pretty much anyone. If it isn't fresh, it isn't worth the calories.
5. Don't give fruitcake as a food gift, because all the fruitcake jokes known to man are bound to ensue moments after it is unwrapped.
6. Don't give a gift assortment of dark chocolates to someone who is passionate about milk chocolate (or vice versa). The same goes for giving cream-filled chocolates to someone who is wild about nuts and chews.
7. Don't give alcohol or anything with caffeine to a member of the Church of Jesus Christ of Latter-Day Saints. These items are not in line with their beliefs.
8. If you don't know the gift recipient all that well, avoid holiday processed meat gift packs (from gourmet catalogue companies) or other foods containing meat, in case your giftee is a vegetarian.
9. Don't give food gifts that include chocolate, peppermint or spearmint, garlic and onions, coffee, caffeinated tea, citrus, tomato products, or chili peppers, to someone who suffers from acid reflux.
10. Don't give any food containing pork or pork products, or that combines dairy with meat products, to someone who keeps kosher or observes Muslim dietary laws.
11. Don't give peanut brittle, caramel apples, or candy canes to people with braces. According to H. Dixon Taylor, DDS, an orthodontist in Concord, Calif., these are the three worst food gifts for someone with orthodontics. (And about 20% of Taylor's clients happen to be grown-ups.)
12. To that friend of yours who is working hard to lose extra pounds, don't give a gift card to The Cheesecake Factory.
13. Don't give chocolate-covered insects to people who might be "bugged" by it. I'm serious -- this actually happened to an acquaintance's mom, and she was definitely not amused!

Labels: acid reflux, IBS, Irritable Bowel Syndrome

Researchers at the University of Pennsylvania School of Medicine have discovered stem cells in the esophagus of mice that were able to grow into tissue-like structures and when placed into immune-deficient mice were able to form parts of an esophagus lining. The investigators report their findings online this month in the Journal of Clinical Investigation.

"The immediate implication is that we'll have a better understanding of the role of these stem cells in normal biology, as well as in regenerative and cancer biology," says senior author Anil K. Rustgi, MD, the T. Grier Miller Professor of Medicine and Genetics and Chief of Gastroenterology. "Down the road, we will develop a panel of markers that will define these stem cells and use them in replacement therapy for diseases like gastroesophogeal reflux disease [GERD] and also to understand Barrett's esophagus, a precursor to esophageal adenocarcinoma and how to reverse that before it becomes cancer."

Diseases of the esophagus are very common in the United States and worldwide. "Benign forms include GERD and millions are affected," notes Rustgi.

GERD can sometimes lead to inflammation of the esophagus, called esophagitis. "In some of these cases esophagitis can lead to a swapping of the normal lining of the esophagus with a lining that looks more like the intestinal lining and that's called Barrett's esophagus," explains Rustgi. "This can lead to cancer of the esophagus, which is the fastest rising cancer in the US, increasing by 7 to 8 percent a year."

The researchers set out to identify and characterize potential stem cells--those with the ability to self renew--in the esophagus to understand normal biology and how injured cells may one day be repaired.

First, they grew mouse esophageal cells they suspected were adult stem cells. Those cells formed colonies that self renewed. These cells then grew into esophageal lining tissue in a three-dimensional culture apparatus. "These tissue culture cells formed a mature epithelium sitting on top of the matrix," says Rustgi. "The whole construct is a form of tissue engineering."

The investigators then tested their pieces of esophageal lining in whole animals. When the tissue-engineered patches were transplanted under the skin of immunodeficient mice, the cells formed epithelial structures. Additionally, in a mouse model of injury of the esophagus in a normal mouse, which mimics what happens during acid reflux, green-stained stem cells migrated to the injured lining cells and co-labeled with the repaired cells, indicating involvement of the stem cells in tissue repair and regeneration.

Eventually the researchers will develop genetically engineered mouse models to be able to track molecular markers of esophageal stem cells found in a micorarray study. The group has already developed a library of human esophageal cell lines and is looking for human versions of markers already identified in mice.

"The ultimate goal is to identify esophageal stem cells in a patient, grow the patient's own stem cells, and inject them locally to replace diseased tissue with normal lining," says Rustgi.

Penn co-authors are Jiri Kalabis, Kenji Oyama, Takaomi Okawa, Hiroshi Nakagawa, Carmen Z. Michaylira, Douglas B. Stairs, and J. Alan Diehl (Department of Cancer Biology), as well as Jose-Luiz Figueiredo and Umar Mahmood from Massachusetts General Hospital, Molecular Center for Imaging Research, Boston, and Meenhard Herlyn, from The Wistar Institute, Philadelphia.

This work was funded by the National Institute of Diabetes and Digestive and Kidney Diseases and the National Cancer Institute.

This release and a related image can be found at: http://www.uphs.upenn.edu/news/News_Releases/2008/12/esophagus-tissue-growth.html

PENN Medicine is a $3.6 billion enterprise dedicated to the related missions of medical education, biomedical research, and excellence in patient care. PENN Medicine consists of the University of Pennsylvania School of Medicine (founded in 1765 as the nation's first medical school) and the University of Pennsylvania Health System.

Penn's School of Medicine is currently ranked #4 in the nation in U.S.News & World Report's survey of top research-oriented medical schools; and, according to most recent data from the National Institutes of Health, received over $379 million in NIH research funds in the 2006 fiscal year. Supporting 1,700 fulltime faculty and 700 students, the School of Medicine is recognized worldwide for its superior education and training of the next generation of physician-scientists and leaders of academic medicine.

The University of Pennsylvania Health System (UPHS) includes its flagship hospital, the Hospital of the University of Pennsylvania, rated one of the nation's top ten "Honor Roll" hospitals by U.S.News & World Report; Pennsylvania Hospital, the nation's first hospital; and Penn Presbyterian Medical Center. In addition UPHS includes a primary-care provider network; a faculty practice plan; home care, hospice, and nursing home; three multispecialty satellite facilities; as well as the Penn Medicine at Rittenhouse campus, which offers comprehensive inpatient rehabilitation facilities and outpatient services in multiple specialties.

University of Pennsylvania School of Medicine
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http:// www.med.upenn.edu

Labels: acid reflux, esophagus

A pre-cancerous condition linked to chronic acid reflux often gets overlooked. Can the medical community do a better job intervening? Researchers from the Hutchinson-MRC Research Centre in Cambridge think so.

In a review published in the inaugural issue of Disease Models & Mechanisms (DMM), experts on a disease known as "Barrett's oesophagus" discuss how "Barrett's" presents unique challenges in diagnosis and treatment. They cite key factors which make this illness difficult to detect, and suggest how scientists and doctors can team up to improve the odds of intervention.

Doctors want to understand more about this condition because patients with Barrett's have 30 to 125 times increased risk of an often fatal cancer of the oesophagus. One of the most common indicators of Barrett's is severe and chronic acid reflux. The authors of the review article discuss several reasons why most Barrett's cases are undiagnosed. The wide-spread availability of over-the-counter antacid medications may contribute by suppressing symptoms such that only the most severe and persistent cases of acid reflux are recommended for screening. Additionally, in order to screen for Barrett's, the oesophagus must be examined with a small light and camera (endoscope) which is not a routine procedure.

The biological basis of Barrett's is an abnormal change, or dysplasia, in the oesophagus. Normally, the oesophagus is lined with flat-shaped cells known as squamous cells. However, in patients with Barrett's, the cell lining consists of rectangular-shaped columnar cells. This process of normal cells morphing into abnormal cells is common to several types of cancer, not just oesophageal cancer. Thus, a greater understanding of Barrett's can also lead to potential therapies for similar pre-cancerous conditions.

In order to advance the diagnosis of Barrett's oesophagus, researchers recommend identifying standardized indicators which can be used to identify the presence of Barrett's as well as predict the likelihood that it will progress into cancer. Additionally, they recommend developing less costly screening methods to allow routine checks for Barrett's in patients with acid reflux. They point out the need for developing laboratory animal models of this disease in order to study the underlying molecular mechanisms of Barrett's, as well as to test potential novel therapies.

The review was written by Massimilian di Pietro, Christopher J. Peters and Rebecca C. Fitzgerald of the Hutchinson-MRC Research Centre in Cambridge, UK. The report was published in the inaugural July/August issue of a new research journal, Disease Models & Mechanisms (DMM), published by The Company of Biologists, a non-profit based in Cambridge, UK.

The DMM website is located at: http://dmm.biologists.org

Labels: acid reflux, Cancer

Labels: acid reflux, GERD

Labels: acid reflux

Labels: acid reflux, GERD

Johns Hopkins Health Alerts has just published a review of the new GERD guidelines, for safe, effective treatment of your acid reflux.

Treating GERD Effectively

There are four types of treatments for gastroesophageal reflux disease (GERD): lifestyle measures, medication, surgery, and endoscopic procedures.

Why it is important to treat GERD

Treating GERD is important. Untreated GERD can lead to serious complications, such as esophageal ulcers (nonhealing mucosal defects), esophageal strictures, Barrett's esophagus (a disorder of the cells lining the esophageal mucosa, which may lead to cancer), and even esophageal cancer.

Lifestyle changes to treat GERD

Doctors often recommend lifestyle changes as the first-line treatment for acid reflux. These measures can include elevating the head of the bed during sleep, not eating late at night, and avoiding alcohol or spicy foods.

New findings on effective treatments for GERD

However, a new study reported in "The Archives of Internal Medicine" (Volume 166, page 965) shows that NOT ALL of these changes are helpful in relieving GERD symptoms, and some may be unnecessarily restrictive.

Researchers looked at the results of 100 studies conducted on various lifestyle measures for GERD. Only losing weight and elevating the head of the bed showed a CLEAR BENEFIT in well-designed studies.

Other measures not found to be effective

In comparison, there was little evidence to support avoiding many suspected GERD triggers, such as alcohol, caffeine, chocolate, spicy foods, citrus, carbonated beverages, fatty foods, and mint. The same was true for sleeping on your left side or avoiding food late at night.

Although there was evidence that some of these substances and practices can cause GERD symptoms, evidence was lacking that avoiding them will relieve symptoms.

Bottom line advice on treating GERD

However, if you experience worsening GERD symptoms after eating certain foods or drinking specific beverages you should probably avoid them. In addition, you should certainly give lifestyle changes a chance before trying medication to relieve your GERD symptoms.

For the latest health alerts on GERD (acid reflux), sour stomach, and other digestive disorders, please visit the Johns Hopkins Health Alerts Digestive Disorders Topic Page at: Johns Hopkins Health Alerts Digestive Disorders

This article is exceprted from the annual Johns Hopkins White Paper: Digestive Disorders. For more information about this book, please visit: Johns Hopkins White Paper: Digestive Disorders

Johns Hopkins Health Alerts

Labels: acid reflux, GERD

Labels: acid reflux, Food Safety, Heartburn, stomach acid, Video

MedicalNews

According to results of a survey presented at the 72nd Annual Scientific Meeting of the American College of Gastroenterology, nighttime acid reflux, along with some of the less typical manifestations or symptoms of gastroesophageal reflux disease (GERD), is associated with significant sleep impairment.

In a recent national survey, researchers assessed the prevalence of sleep impairment among people with GERD and people without GERD based on response to an Internet survey of a general population of U.S. adults. Using a validated GERD screening tool, 701 respondents were identified with GERD and the remaining were controls. Bonnie Dean, MPH, PhD, of Cerner LifeSciences, Ronnie Fass, MD of the University of Arizona and their research team found that sleep impairment was more common among people with GERD (41.9 percent) than those without GERD (19.4 percent). Researchers found that 49.5 percent of respondents with nighttime GERD reported sleeping poorly often or most of the time, compared to 36.7 percent of people with daytime GERD.

Using the survey, researchers also assessed sleep impairment among patients experiencing frequent nighttime atypical manifestations of GERD. In this case, Dr. Dean and her colleagues evaluated the subgroup of respondents with GERD, as identified using the validated GERD screener. They found that atypical manifestations or symptoms of GERD (i.e. coughing, sore throat, snoring, wheezing, choking, and chest pain) were common among those with acid reflux. Of GERD patients, 74 percent had at least one nighttime atypical manifestation. For almost every daytime and nighttime atypical manifestation assessed, more than 20 percent of GERD patients reported their occurrence as frequent (more than 2 days or nights per week). Researchers also found that sleep impairment was more common among GERD patients with atypical manifestations compared to GERD patients with only typical or classic symptoms such as heartburn and acid regurgitation. For eight of the nine nighttime atypical manifestations assessed, the proportion of GERD cases reporting sleep impairment was significantly higher for GERD cases with the atypical manifestation compared with GERD cases without the atypical manifestation.

"Awareness of nighttime reflux, atypical manifestations, and associated sleep complaints should allow more complete evaluation and treatment of GERD patients," said Dr. Dean about this project.

Tips for Calming Nighttime Acid Reflux Heartburn and other gastroesophageal reflux disease (GERD) symptoms experienced during the night commonly cause sleep disturbances, including arousal from sleep, increased wakefulness and overall poor sleep quality.

Here are several tips to help reduce nighttime acid reflux so you can sleep better:

* Sleep with your head and shoulders elevated
* Wear loose-fitting clothes
* Wait 2 to 3 hours after eating to go to sleep
* Avoid foods that trigger heartburn

Labels: acid reflux, GERD

MedicalNews

New research from scientists at UT Southwestern Medical Center and the Dallas Veterans Affairs Medical Center underscores the importance of preventing recurring acid reflux while also uncovering tantalizing clues on how typical acid reflux can turn potentially cancerous.

In research published in July and August, scientists discovered that people with acid reflux disease, particularly those with a complication of acid reflux called Barrett's esophagus, have altered cells in their esophagus containing shortened telomeres, the ending sequences in DNA strands. Combined with related research to be published this month, the findings indicate that the shortened sequences might allow other cells more prone to cancer to take over.

"The research supports why it is important to prevent reflux, because the more reflux you have and the longer you have it, the more it might predispose you to getting Barrett's esophagus. So you want to suppress that reflux," said Dr. Rhonda Souza, associate professor of internal medicine at UT Southwestern and lead author of the paper which appeared in the American Journal of Physiology -- Gastrointestinal and Liver Physiology.

Heartburn occurs when acid splashes back up from the stomach into the esophagus, the long feeding tube that connects the stomach and throat, causing a burning sensation.

Over time, the persistent acid bath can cause normal skin-like cells in the esophagus to change into tougher, more acid-resistant cells of the type found in the stomach and intestine, a condition called Barrett's esophagus, explained Dr. Stuart Spechler, professor of internal medicine and senior author of the paper. "Unfortunately, those acid-resistant cells are also more prone to cancer," Dr. Spechler said.

Adenocarcinoma of the esophagus, the cancer that is especially associated with Barrett's esophagus, is currently the most rapidly rising cancer in the U.S., with a sixfold increase in cases during the past 30 years, according to the National Cancer Institute.

Understanding how and why the cells change in some cases and not others has been a major challenge for investigators.

Researchers compared telomere length and telomerase activity in biopsy specimens from 38 patients with GERD and 16 control patients. This new line of research suggests that the continuous acid bath affecting esophageal cells causes them to divide more frequently in order to regenerate the damaged lining. However, each time the cells divide, the telomeres at the end of DNA become shorter. When they become too short, the aging cell can no longer divide, Dr. Souza said.

Scientists suspect that when cells can no longer divide, other cells might infiltrate the area to make up for the loss. And those cells may be more likely to generate the acid-resistance that makes them more likely to turn cancerous.

"If the telomeres get short enough, maybe the cells can't regenerate any more and maybe that's why you start to see this change," said Dr. Spechler. "Perhaps the esophagus can't regenerate the normal skin-like squamous cells, and instead, it has to recruit cells from somewhere else and that's why you start getting these changes to intestinal-like cells."

Other studies by this group of UT Southwestern digestive disease specialists suggest the alternate cells that eventually take over might be bone-marrow cells.

"There could be cells circulating from the bone marrow that wouldn't ordinarily end up in the esophagus. But if you shorten the telomeres enough and the esophagus can't regenerate anymore, perhaps these bone-marrow cells might have to replace that tissue, and bone-marrow cells can turn into intestinal tissue," Dr. Spechler said. "This hasn't been proven, but we have some data that supports that."

In research available online prior to printing this month in Diseases of the Esophagus, Drs. Souza, Spechler and colleagues demonstrate that bone-marrow cells come into play to regenerate the esophageal lining in rats that have heavy reflux.

"So the first paper shows that the telomeres are short, suggesting that the normal squamous cells might not be able to divide anymore, so they die out," Dr. Spechler said. "The second paper suggests that the bone-marrow cells may then come and take their place, giving rise to the intestinal cells instead of the normal, skin-like cells."

Further research will be needed to confirm that hypothesis, Dr. Souza said.

"It's an interesting series of experiments," she said. "None of them absolutely prove that this is what's going on, but it's an interesting concept, and it certainly supports the theory that your normal cells poop out and eventually they can't replace the damaged ones, and maybe that's why you get Barrett's esophagus."

If confirmed, the research might also help scientists find a way to prevent the bone-marrow cells from invading or to identify markers that would allow an earlier diagnosis for Barrett's esophagus, which doesn't usually have symptoms.

Labels: acid reflux, GERD

Medicalnews

A new study, published in the journal "Digestion", determined the diagnostic and therapeutic response of the Reflux Disease Questionnaire (RDQ) using the symptom association probability as reference. The symptom association probability objectively determines with a Fisher exact test whether symptoms are due to reflux events taking all symptom episodes and reflux events into account. In addition, the RDQ's construct validity and its relationship to quality of life were ascertained.

Seventy-four patients with gastro-oesophageal reflux disease (GORD) symptoms (age 51 years (22-78); male 62%) derived from primary care completed the RDQ, Gastrointestinal Rating Scale and Quality of Life in Reflux and Dyspepsia (QOLRAD) questionnaires before and after a two-week course of esomeprazole, a proton pump inhibitor (40 mg daily). The symptom association probability was determined by a 24-hour pH recording before proton pump inhibitor treatment. The diagnostic abilities of the RDQ (total and 4 dimensions scores) were assessed with the area under the curve of a receiver operating curve. RDQ scores before and after proton pump inhibitor treatment were compared with Wilcoxon tests. Multiple linear regressions assessed the RDQ's construct validity (Gastrointestinal Rating Scale) and relationship to quality of life (QOLRAD).

The areas under the curve were low for all RDQ dimensions (<0.6). In patients positive for symptom association probability all RDQ dimensions improved (p < 0.0001) while the scores of those negative for symptom association probability did not (heartburn p < 0.01; GORD and total score p < 0.05; regurgitation and dyspepsia not significant). The RDQ was related to the total and reflux dimensions of the Gastrointestinal Rating Scale, while the food and drink quality of life dimension was linearly associated with the RDQ.

Therefore, the RDQ is a valid and reliable questionnaire with excellent construct validity and a good relationship to quality of life. The diagnostic value of the RDQ in primary care is limited, but combination with an additional proton pump inhibitor treatment course might improve the RDQ's ability to discriminate GORD patients according to their symptom association probability outcome.

Labels: acid reflux, Gastrointestinal

By THOMAS H. MAUGH II
Los Angeles Times

Older people who take heartburn drugs such as Nexium, Prilosec, Prevacid and Protonix for long periods have a significantly increased risk of hip fractures, possibly because the drugs block calcium absorption, Pennsylvania researchers reported Wednesday.

The drugs, which block production of acid in the stomach, are among the most widely used in the United States with combined annual sales of more than $10 billion.

"The perception is that the drugs are completely safe, and doctors dispense them without thinking too much about the risks and the benefits," said Dr. Yu-Xiao Yang of the University of Pennsylvania School of Medicine, who led the study published in the Journal of the American Medical Association.

Now, he said, physicians should be aware of the potential risk, prescribe the lowest possible dose and use the drug only on patients who really need it.

Men using heartburn drugs ran twice risk of women, study says

An estimated 300,000 Americans older than 65 sustain hip fractures each year, according to the National Institutes of Health, and recovery is difficult. About 20 percent die of complications and another 20 percent are consigned permanently to nursing homes.

The findings are interesting, said Dr. Alan Buchman of Northwestern University, but the results do not prove that the drugs caused the increased risk.

"Maybe they have some other problem that increases the risk for fractures," he said.

Even if the drugs are at fault, the solution may be simply to consume more calcium, either in the form of dairy products or as supplements, said Buchman, who was not involved in the study. "The average North American doesn't get enough calcium anyway," he said.

Drug manufacturers noted that the products have been used for more than 10 years and have been through many clinical trials without evidence of risk.

Amy Allen, a spokeswoman for TAP Pharmaceuticals Inc. of Lake Forest, Ill., which manufactures Prevacid, said the company has an extensive post-marketing surveillance system and "has not identified a safety signal for bone fractures related to Prevacid."

Heartburn typically occurs when acid from the stomach bubbles up into the esophagus, a condition called acid reflux. It is very painful and can cause ulcers on the lining of the esophagus. Some researchers believe it also can lead to cancer.

Yang and his colleagues used a large British database to identify 13,566 hip fracture patients over age 50 and a matched group of 135,386 healthy people.

They found that one year of using the drugs increased risk of hip fractures by 44 percent. Long-term users who received high doses of the drugs had as much as 2.6 times the normal risk.

Men using the drugs had about twice the risk of hip fractures as did women, perhaps because the women were more likely to be consuming calcium supplements as post-menopausal therapy.

Patients taking a different class of acid inhibitors that includes Tagamet, Zantac, Pepcid and Axid had a 21 percent increased risk of fractures after one year.

The results are similar to those obtained in a smaller Danish study reported this year, Yang said.

Yang, who has received funding from several manufacturers, pointed out that adequate levels of acid are required in the duodenum to dissolve calcium salts so they can be absorbed by the body. Studies in animals have suggested that the acid blockers can interfere with this process, producing a calcium deficiency that, in turn, leads to a thinning of bones.

What's needed now, Buchman said, is a study that looks directly at bone-mineral density to determine whether it decreases in patients receiving the drugs.

The study was funded by the National Institutes of Health and the American Gastroenterological Association/GlaxoSmithKline Institute for Digestive Health.

Heartburn typically occurs when acid from the stomach bubbles up into the esophagus, a condition called acid reflux. It is very painful and can cause ulcers on the lining of the esophagus. Some researchers believe it also can lead to cancer.

Labels: acid reflux, Heartbun, ulcer