Guest guest Posted January 31, 2012 Report Share Posted January 31, 2012 my dr prescribe me acid blockers after my HM (April 2010)) I have been taking them for almost a year until recently I stopped because they're not helping me not to say that they might help others but not working for me. from So Cal Sent via BlackBerry by AT & T POST HM Acid Blockers Curious if anyone here has been prescribed an acid blocker after having a HM and are they taking it. I had my HM recently doc has me on one for 2 months. I'm uneasy about taking these but I guess for 2 months I might tolerate it. Just need to be careful. Any comments welcome. Thanks Quote Link to comment Share on other sites More sharing options...
Guest guest Posted January 31, 2012 Report Share Posted January 31, 2012 I came home with a bottle of ninety Nexium. In five weeks, I've taken five. So I'm good to go for the next year and a half, lol! Bottle says: take every day before breakfast, but I only take them if I get reflux. I *hate* taking meds I don't have to; so if I'm not having a problem, pumping chemicals in is not my cuppa. I have NO problem taking them if I need them though. I think my lack of acid reflux may be tied to the fact that I'm still not able to get off of all soft (though I keep trying): the ol E still seems pretty tight. . . . I still regurge daily, but just a tiny bit, and I'd have to say is IS about 95% better than before the Heller, so even if it never gets better than this I am going to consider my blessed. > > my dr prescribe me acid blockers after my HM (April 2010)) I have been taking them for almost a year until recently I stopped because they're not helping me not to say that they might help others but not working for me. > from So Cal > Sent via BlackBerry by AT & T > > POST HM Acid Blockers > > Curious if anyone here has been prescribed an acid blocker after having a HM and are they taking it. I had my HM recently doc has me on one for 2 months. I'm uneasy about taking these but I guess for 2 months I might tolerate it. Just need to be careful. Any comments welcome. > > Thanks > > > > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted January 31, 2012 Report Share Posted January 31, 2012 I know long term they're not good. Even short term they just prevent the body's natural nutrient absorption process. I've started reading the book " Why stomach acid is good for you " It's an eye opener. Quote Link to comment Share on other sites More sharing options...
Guest guest Posted January 31, 2012 Report Share Posted January 31, 2012 wrote: > > I know long term they're not good. Even short term they just prevent the > body's natural nutrient absorption process. I've started reading the book > " Why stomach acid is good for you " It's an eye opener. > They are not good if you don't need them. They can be very good if you do, but everything comes with a price. Even the natural air we breath and the natural water we drink take there toll on our bodies. We started dieing before we were born, still in the womb. Choose your poison I say. Sun shine, water, calcium, vitamins, and even food is good for you but you don't want to get too much of them. Likewise PPIs can be good and bad. I feel about book authors like I do about entertainers when it comes to health. An author is in the business of selling books. Even if he is right for 99% of the people there is a lot of room in that remaining 1% for all the people with achalasia. What is true for others may not be true for us. Even lists of things that relax the LES (lower esophageal sphincter) can not be trusted by us because somethings that relax the LES for others actually increase the pressure of the LES for us, but not everything on those lists is like that. It needs to be understood that H2 blockers and PPIs in most people don't stop acid production they just reduce it. You still have acid to digest food and release nutrients from the food. If there is a problem for some people it is more likely at high doses. Some people here do take high doses but even then they don't stop their acid production or they wouldn't be needing that much medication and could get by with less. If you did completely stop your acid production you would be taking too much unless it was for some temporary reason. The amount of acid in the stomach and pH of it goes up and down with eating and not eating and what was in what you ate. It isn't like there is some magic amount of acid that we should have. It should also be understood why acid reflux is bad for people with achalasia. People with achalasia don't have normal esophageal peristalsis they may not have any. That means that when acid is refluxed into the esophagus peristalsis may not work to clear it from the esophagus, also there may not be any food or drink above it for gravity to work with and clear it. That means even a little acid could sit a long time in the esophagus burning and injuring it. In time that damage can cause scarring which can lead to esophageal strictures and myotomy failure. Long-term acid damage can increase the risk of Barrett's esophagus and cancer. If you don't have an acid problem then even if you have achalasia you don't need acid reducers. If you do have an acid problem then you need to decide if you would risk cancer, Barrett's or myotomy failure based on the ideas in someones book. Link: Very late results of esophagomyotomy for patients with achalasia: clinical, endoscopic, histologic, manometric, and acid reflux studies in 67 patients for a mean follow-up of 190 months. http://www.ncbi.nlm.nih.gov/pubmed/16432352 " ...there is a progressive clinical deterioration of initially good results if a very long follow-up is performed (23 years after surgery), mainly due to an increase in pathologic acid reflux disease and the development of short- or long-segment Barrett esophagus. " notan Quote Link to comment Share on other sites More sharing options...
Guest guest Posted January 31, 2012 Report Share Posted January 31, 2012 Notan, Good information. For me, I never had an acid reflux problem as far as I know. My GI initially told me that I " may " have silent reflux. The end diagnosis was A. My surgeon told me to take it for 2 months. Then, " I myself " would need to decide after the 2 months whether I needed to continue with it. Since my HM about 3 weeks ago, I've had 2-3 instances of acid reflux which he said was common. I have not had any in a week. To me it seems to be a gray area. Is there such a thing as " silent " reflux after a HM? george -- The real meaning of success is how much control you have of your life ! Quote Link to comment Share on other sites More sharing options...
Guest guest Posted January 31, 2012 Report Share Posted January 31, 2012 wrote: > > ... Is there such a thing as " silent " reflux after a HM? > Yes. It is reflux without the symptom of heartburn. With achalasia the damage to the esophageal nerves can mean that some people do not feel any pain (heartburn) from acid reflux even though it may be doing damage. Others become hypersensitive and have pain even though there is little acid. Because we can't all tell if we have heartburn some doctors will put all their myotomy patients on acid reducing medications. Others have the patients come back for endoscopy or 24h pH testing. Depending on the results then medication may be suggested. Some patient eventually quit coming in for follow-up while reflux may become worse with time. The patients learns to live with the reflux or can't feel it but damage is being done. Another problem is that some people with achalasia have spasms or other NCCPs (Non-Cardiac Chest Pain) that can feel like heartburn. If reflux develops later they may just think it is spasms or NCCPs. Quote Link to comment Share on other sites More sharing options...
Guest guest Posted February 1, 2012 Report Share Posted February 1, 2012 , It's my understanding that with an H2 Blocker or PPI, they are not effective if you just take them when you have a flare up. They need to be taken consistently. I don't believe you can " pop " them like tums. ' -- The real meaning of success is how much control you have of your life ! Quote Link to comment Share on other sites More sharing options...
Guest guest Posted May 14, 2012 Report Share Posted May 14, 2012 Hi , My son had HM about 10 months back and his surgeon Dr, Dempsey recommended that he take 20mg pepcid throughout his life. It does prevent his acid reflex problem...I guess that the 20mg helps his esophagus lining as well since the acid can burn it. I too am sometimes concerned if the medicine can have side effect due to long term use of it, will ask the GI on the 1 year anniversary of the surgery in July. Thanks, Priti ________________________________ From: gkalmancy <gkalmancy@...> achalasia Sent: Tuesday, January 31, 2012 7:57 AM Subject: POST HM Acid Blockers  Curious if anyone here has been prescribed an acid blocker after having a HM and are they taking it. I had my HM recently doc has me on one for 2 months. I'm uneasy about taking these but I guess for 2 months I might tolerate it. Just need to be careful. Any comments welcome. Thanks Quote Link to comment Share on other sites More sharing options...
Guest guest Posted May 14, 2012 Report Share Posted May 14, 2012 It affects digestion. Check out taking B12 and other nutrients that may not be broken down with an altered stomach PH. There are a more than just B12. Sent from my iPod On May 14, 2012, at 21:44, Preeti Mahajan <priti19.mahajan@...> wrote: > Hi , > > My son had HM about 10 months back and his surgeon Dr, Dempsey recommended that he take 20mg pepcid throughout his life. > > It does prevent his acid reflex problem...I guess that the 20mg helps his esophagus lining as well since the acid can burn it. > > I too am sometimes concerned if the medicine can have side effect due to long term use of it, will ask the GI on the 1 year anniversary of the surgery in July. > > Thanks, > Priti > > ________________________________ > From: gkalmancy <gkalmancy@...> > achalasia > Sent: Tuesday, January 31, 2012 7:57 AM > Subject: POST HM Acid Blockers > > > > Curious if anyone here has been prescribed an acid blocker after having a HM and are they taking it. I had my HM recently doc has me on one for 2 months. I'm uneasy about taking these but I guess for 2 months I might tolerate it. Just need to be careful. Any comments welcome. > > Thanks > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted May 16, 2012 Report Share Posted May 16, 2012 I stopped taking the prescribed meds after the 2 months. I have had no reflux at all. I do sleep in an elevated position at night though. Long term use can't be good. I know that the older we get, we produce less and less acid in our stomach. This prohibits the absorption of essential nutrient s our bodies need. Quote Link to comment Share on other sites More sharing options...
Guest guest Posted May 17, 2012 Report Share Posted May 17, 2012 Interesting! I haven't had my HM yet, but Dr. Dempsey will perform the surgery and he told me, too, that I should stay on reflux meds for the rest of my life. I am very ambivalent about it, so I was glad to read this thread. Thank you for all of the information! I will definitely talk to him about it again. Has anyone been on reflux meds for years and years, and if so, have you had any issues with side effects? I haven't read all of the links provided yet, so maybe there is info in there, but I would love to hear first-hand accounts. Thanks! > > Hi , > > My son had HM about 10 months back and his surgeon Dr, Dempsey recommended that he take 20mg pepcid throughout his life. > > It does prevent his acid reflex problem...I guess that the 20mg helps his esophagus lining as well since the acid can burn it. > > I too am sometimes concerned if the medicine can have side effect due to long term use of it, will ask the GI on the 1 year anniversary of the surgery in July. > > Thanks, > Priti > > > ________________________________ > From: gkalmancy <gkalmancy@...> > achalasia > Sent: Tuesday, January 31, 2012 7:57 AM > Subject: POST HM Acid Blockers > > >  > Curious if anyone here has been prescribed an acid blocker after having a HM and are they taking it. I had my HM recently doc has me on one for 2 months. I'm uneasy about taking these but I guess for 2 months I might tolerate it. Just need to be careful. Any comments welcome. > > Thanks > > > > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted May 17, 2012 Report Share Posted May 17, 2012 It can affect nutrition, absorption, especially B12. You are changing the PH of your digestive tract and therefore the ability to digest, metabolize and absorb certain nutrients. I bet the resident nutritionist can explain it better. Zantac might be better or something like it as it is not a PPI. Sent from my iPod On May 17, 2012, at 19:38, " erin_lievens " <erinl@...> wrote: > Interesting! I haven't had my HM yet, but Dr. Dempsey will perform the surgery and he told me, too, that I should stay on reflux meds for the rest of my life. I am very ambivalent about it, so I was glad to read this thread. Thank you for all of the information! I will definitely talk to him about it again. > > Has anyone been on reflux meds for years and years, and if so, have you had any issues with side effects? I haven't read all of the links provided yet, so maybe there is info in there, but I would love to hear first-hand accounts. > > Thanks! > > > > > > > Hi , > > > > My son had HM about 10 months back and his surgeon Dr, Dempsey recommended that he take 20mg pepcid throughout his life. > > > > It does prevent his acid reflex problem...I guess that the 20mg helps his esophagus lining as well since the acid can burn it. > > > > I too am sometimes concerned if the medicine can have side effect due to long term use of it, will ask the GI on the 1 year anniversary of the surgery in July. > > > > Thanks, > > Priti > > > > > > ________________________________ > > From: gkalmancy <gkalmancy@...> > > achalasia > > Sent: Tuesday, January 31, 2012 7:57 AM > > Subject: POST HM Acid Blockers > > > > > >  > > Curious if anyone here has been prescribed an acid blocker after having a HM and are they taking it. I had my HM recently doc has me on one for 2 months. I'm uneasy about taking these but I guess for 2 months I might tolerate it. Just need to be careful. Any comments welcome. > > > > Thanks > > > > > > > > > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted May 17, 2012 Report Share Posted May 17, 2012 I've been on daily 20mg for 6 years now with no side effects. I feel good. It allows me to eat most everything. I've had a pretty normal life. I had my HM 30 years ago. Sent from my iPhone Marisol Cappello On May 17, 2012, at 8:38 PM, " erin_lievens " <erinl@...> wrote: > Interesting! I haven't had my HM yet, but Dr. Dempsey will perform the surgery and he told me, too, that I should stay on reflux meds for the rest of my life. I am very ambivalent about it, so I was glad to read this thread. Thank you for all of the information! I will definitely talk to him about it again. > > Has anyone been on reflux meds for years and years, and if so, have you had any issues with side effects? I haven't read all of the links provided yet, so maybe there is info in there, but I would love to hear first-hand accounts. > > Thanks! > > > > > > > Hi , > > > > My son had HM about 10 months back and his surgeon Dr, Dempsey recommended that he take 20mg pepcid throughout his life. > > > > It does prevent his acid reflex problem...I guess that the 20mg helps his esophagus lining as well since the acid can burn it. > > > > I too am sometimes concerned if the medicine can have side effect due to long term use of it, will ask the GI on the 1 year anniversary of the surgery in July. > > > > Thanks, > > Priti > > > > > > ________________________________ > > From: gkalmancy <gkalmancy@...> > > achalasia > > Sent: Tuesday, January 31, 2012 7:57 AM > > Subject: POST HM Acid Blockers > > > > > >  > > Curious if anyone here has been prescribed an acid blocker after having a HM and are they taking it. I had my HM recently doc has me on one for 2 months. I'm uneasy about taking these but I guess for 2 months I might tolerate it. Just need to be careful. Any comments welcome. > > > > Thanks > > > > > > > > > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted May 17, 2012 Report Share Posted May 17, 2012 Hi >that I should stay on reflux meds for the rest of my life I post this quite often, if over 50 age and have been on PPI's for 5 years, DONT fall, you may break a hip. I was on Nexium 40 mg for several years, made my stomach alkaline so very hard to digest food. I had to use digesive enzymes which helped. Now off all PPI's and no HM. No indigestion ever, last 3 years.In my case I just clean out the e. http://www.fda.gov/Drugs/DrugSafety/PostmarketDrugSafetyInformationforPatientsan\ dProviders/ucm213206.htm Read the tables. Ray CA OC 81 > > > > Hi , > > > > My son had HM about 10 months back and his surgeon Dr, Dempsey recommended that he take 20mg pepcid throughout his life. > > > > It does prevent his acid reflex problem...I guess that the 20mg helps his esophagus lining as well since the acid can burn it. > > > > I too am sometimes concerned if the medicine can have side effect due to long term use of it, will ask the GI on the 1 year anniversary of the surgery in July. > > > > Thanks, > > Priti > > > > > > ________________________________ > > From: gkalmancy <gkalmancy@> > > achalasia > > Sent: Tuesday, January 31, 2012 7:57 AM > > Subject: POST HM Acid Blockers > > > > > >  > > Curious if anyone here has been prescribed an acid blocker after having a HM and are they taking it. I had my HM recently doc has me on one for 2 months. I'm uneasy about taking these but I guess for 2 months I might tolerate it. Just need to be careful. Any comments welcome. > > > > Thanks > > > > > > > > > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted May 18, 2012 Report Share Posted May 18, 2012 Thanks, Ray! I *am* square in the middle of the risk population. Plus, because of my thyroidectomy in '85, I have an out of kilter calcium bone deposit system (aka damaged parathyroids -- whose job it is to keep calcium balanced between blood and bone). Knowing just how reluctant the FDA is to make such judgements, it's even more impressive. > > > > > > Hi , > > > > > > My son had HM about 10 months back and his surgeon Dr, Dempsey recommended that he take 20mg pepcid throughout his life. > > > > > > It does prevent his acid reflex problem...I guess that the 20mg helps his esophagus lining as well since the acid can burn it. > > > > > > I too am sometimes concerned if the medicine can have side effect due to long term use of it, will ask the GI on the 1 year anniversary of the surgery in July. > > > > > > Thanks, > > > Priti > > > > > > > > > ________________________________ > > > From: gkalmancy <gkalmancy@> > > > achalasia > > > Sent: Tuesday, January 31, 2012 7:57 AM > > > Subject: POST HM Acid Blockers > > > > > > > > >  > > > Curious if anyone here has been prescribed an acid blocker after having a HM and are they taking it. I had my HM recently doc has me on one for 2 months. I'm uneasy about taking these but I guess for 2 months I might tolerate it. Just need to be careful. Any comments welcome. > > > > > > Thanks > > > > > > > > > > > > > > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted May 18, 2012 Report Share Posted May 18, 2012 Thank you everyone! I will definitely bring all of this up with Dr. Dempsey. I suppose I can wait and see if I have trouble with reflux after the surgery. I assume there are tests for silent reflux. If I need it, I have no problem at all taking the meds, but I don't like the idea of taking them if I don't need them. A " just in case " isn't good enough- not with those types of side-effects! > > I stopped taking the prescribed meds after the 2 months. I have had no > reflux at all. I do sleep in an elevated position at night though. Long > term use can't be good. I know that the older we get, we produce less and > less acid in our stomach. This prohibits the absorption of essential > nutrient s our bodies need. > > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted May 23, 2012 Report Share Posted May 23, 2012 Ray wrote: > > > I post this quite often, if over 50 age and have been on PPI's for 5 > years, DONT fall, you may break a hip. > I say if you are over 50 DON'T fall you may break your hip and the PPIs probably have nothing to do with it if it does break. However: if you are over 50 and drink a lot of colas the cola drinking may lead to a fracture. It amazes me that people will avoid something that is not proven to have these problems yet stick with things that are also suspected of causing bone density problems, such as phosphoric acid which is found in colas. Also there is a problem of phosphoric acid and muscles when you drink a lot of it. Personally I don't see doing much about either. But, if I was the worrying type then why not worry about both? notan Quote Link to comment Share on other sites More sharing options...
Guest guest Posted May 24, 2012 Report Share Posted May 24, 2012 Hi notan >However: if you are over 50 and drink a lot of colas the cola drinking may lead to a fracture. Yes this may also be true. Wonder if the FDA has issued a report on this. My wife has osteoporosis at 81, she has never had PPI's or a cola, so I tell her don't fall or you will break a hip. It will happen to most of us. My brother at 85 fell off a curb and broke a leg, dont believe he was on PPI's, just getting old. I remember recently that notan fell and broke both feet/ankles/legs? I know he had a hard time with this. Not sure how it happened or just where the fracture was or what caused it. I hope you are now walking and maybe jogging. A report would be great. I believe that PPI's over long time might also cause osteoporosis for older people, I have looked at the FDA report. Most of the reports say this is true except one. Went through all of the references, sort of hard to digest the summaries, so look at the following. • Six reported an increased risk of fractures with the use of proton pump inhibitors 1,2,3,5,6,7. • Exposure to proton pump inhibitors ranged from a period of 1 to 12 years, depending on the study. • The emergence of fractures varied among studies; with one study reporting an increase in fractures with use of proton pump inhibitors in the previous year 2 and another study finding an increase after 5 to 7 years of proton pump inhibitor use3. • The increased risk of fractures was primarily observed in older individuals. • Two studies reported an increase in fractures with higher doses of proton pump inhibitors 2,5. • Two studies reported an increase in fractures with longer duration of use 2,3. • One study did not find a relationship between proton pump inhibitor use and fractures 4. This study limited the study population to those without major risk factors for fracture. http://www.cmaj.ca/content/179/4/319.abstract http://www.cmaj.ca/content/179/4/319.abstract http://www.ncbi.nlm.nih.gov/pubmed/19931262 http://www.ncbi.nlm.nih.gov/pubmed/16927047 http://www.ncbi.nlm.nih.gov/pubmed/17190895 http://www.ncbi.nlm.nih.gov/pubmed/18657011 http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2902649/ http://www.ncbi.nlm.nih.gov/pubmed/20458083 http://www.fda.gov/Drugs/DrugSafety/PostmarketDrugSafetyInformationforPatientsan\ dProviders/ucm213206.htm Update: 3/23/2011 FDA has determined an osteoporosis and fracture warning on the over-the-counter (OTC) proton pump inhibitor (PPI) medication " Drug Facts " label is not indicated at this time. Following a thorough review of available safety data, FDA has concluded that fracture risk with short-term, low dose PPI use is unlikely. The available data show that patients at highest risk for fractures received high doses of prescription PPIs (higher than OTC PPI doses) and/or used a PPI for one year or more. In contrast to prescription PPIs, OTC PPIs are marketed at low doses and are only intended for a 14 day course of treatment up to 3 times per year. FDA acknowledges that consumers, either on their own, or based on a healthcare professional's recommendation, may take these products for periods of time that exceed the directions on the OTC label. Healthcare professionals should be aware of the risk for fracture if they are recommending use of OTC PPIs at higher doses or for longer periods of time than in the OTC PPI label. If you need them, take them. I hope this will be useful for new people who have recently joined. Ray CA OC 81 No HM or PPI'S > > > > > > I post this quite often, if over 50 age and have been on PPI's for 5 > > years, DONT fall, you may break a hip. > > > > I say if you are over 50 DON'T fall you may break your hip and the PPIs > probably have nothing to do with it if it does break. > > However: if you are over 50 and drink a lot of colas the cola drinking > may lead to a fracture. > > It amazes me that people will avoid something that is not proven to have > these problems yet stick with things that are also suspected of causing > bone density problems, such as phosphoric acid which is found in colas. > Also there is a problem of phosphoric acid and muscles when you drink a > lot of it. > > Personally I don't see doing much about either. But, if I was the > worrying type then why not worry about both? > > notan > > > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted May 25, 2012 Report Share Posted May 25, 2012 This is going to be long. > > >However: if you are over 50 and drink a lot of colas the cola > drinking may lead to a fracture. > Yes this may also be true. Wonder if the FDA has issued a report on this. > There are a number of crazy things that go on with food to which the FDA is silent so I would read much into the silence. > > My wife has osteoporosis at 81, she has never had PPI's or a cola, so > I tell her don't fall or you will break a hip. It will happen to most > of us. My brother at 85 fell off a curb and broke a leg, dont believe > he was on PPI's, just getting old. > Getting old is a much bigger problem for bones than PPIs. > > I remember recently that notan fell and broke both feet/ankles/legs? I > know he had a hard time with this. Not sure how it happened or just > where the fracture was or what caused it. I hope you are now walking > and maybe jogging. A report would be great. > I fell about 10 ft onto concrete that was sloped and each foot landed at a different hight and different slope. I am tall and big and I have narrow ankles that have always been a problem and could not take that much stress. I had a bone density scan one year before and my leg bones had better density than a 30 year old man. Probably because I put so much stress on my legs. On the other hand, my spine is not as dense as it should be probably because I have a vitamin D problem and my spine does not carry the stress that my legs do. My hips are normal for my age. So, even with over 5 years of PPI use my legs were not weakened and actually stronger than most people my age but my ankles and feet were going to bust from that fall even if had never taken PPIs. > > I believe that PPI's over long time might also cause osteoporosis for > older people, I have looked at the FDA report. Most of the reports say > this is true except one. > True that they " might " cause an almost unnoticeable difference, yes, " might " and very small effect. That it is proven true that they do, no, it is not proven true and many doctors do not think the risk is important. If there were a study that found sky divers were more likely to have car accidents would that mean sky diving causes car accidents or would it be simply an association of one action of thrill seeker sky divers to an unrelated outcome of another action of thrill seekers. Sky diving would be associated with a higher car accident risk but would not be causal to the risk. In other words the real increase in risk is because some sky divers are thrill seekers who drive faster. So, what I see in the PPI studies is association not causation and if there is any causation from the PPIs it is very low. The point here is to remember in the rest of this discussion when they say that a study found an association that is not the same as saying they know they have found or proven the cause. Remember that word, " association. " > Went through all of the references, sort of hard to digest the > summaries, so look at the following. > I am going to number the studies and then deal with the rest of your message. If you are not interested in the number skip down to the study conclusions. Study 1 Proton pump inhibitors, histamine H2 receptor antagonists, and other antacid medications and the risk of fracture. http://www.ncbi.nlm.nih.gov/pubmed/16927047 Study 2 Long-term proton pump inhibitor therapy and risk of hip fracture. http://www.ncbi.nlm.nih.gov/pubmed/17190895 Study 3 Use of proton pump inhibitors and risk of osteoporosis-related fractures http://www.cmaj.ca/content/179/4/319.abstract Study 4 Proton pump inhibitor use and risk of hip fractures in patients without major risk factors. http://www.ncbi.nlm.nih.gov/pubmed/18657011 Study 5 Proton Pump Inhibitors and Histamine-2 Receptor Antagonists are Associated with Hip Fractures among At-Risk Patients (Notice that word, " Associated. " ) http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2902649/ Study 6 Proton pump inhibitor use, hip fracture, and change in bone mineral density in postmenopausal women: results from the Women's Health Initiative. http://www.ncbi.nlm.nih.gov/pubmed/20458083 Study 7 Acid-suppressive medications and risk of bone loss and fracture in older adults. http://www.ncbi.nlm.nih.gov/pubmed/18813868 Study 8 Proton-pump inhibitor use is not associated with osteoporosis or accelerated bone mineral density loss. (Read that title again. And yes I know there could be another method.) http://www.ncbi.nlm.nih.gov/pubmed/19931262 Now take a close look at the study conclusions from the abstracts. Remember our word for the day is " association " in all its forms. Conclusion 1 " Proton pump inhibitors appeared to be associated with a limited increase in fracture risk, in contrast to histamine H( 2 ) antagonists, which seemed to be associated with a small decrease in fracture risk. In all cases, the changes in risk estimates were small and the clinical significance was limited. " They say " appeared to be associated " not are causal to. Note also, " limited increase " and " changes in risk estimates were small " and " clinical significance was limited. " Conclusion 2 " Long-term PPI therapy, particularly at high doses, is associated with an increased risk of hip fracture. " Once again it is " associated with " not causal to. Conclusion 3 " Interpretation: Use of proton pump inhibitors for 7 or more years is associated with a significantly increased risk of an osteoporosis-related fracture. There is an increased risk of hip fracture after 5 or more years exposure. Further study is required to determine the clinical importance of this finding and to determine the value of osteoprotective medications for patients with long-term use of proton pump inhibitors. " Nowhere do they say there is a causal relationship but they do use the word " associated. " They also imply they don't know what the clinical importance of the finding is. It may not be important or it may not be of importance to PPIs. Conclusion 4 " Use of PPIs does not increase the risk of hip fracture in patients without major risk factors. The difference in results between our study and that of another, which indicated that PPI use increases the risk of hip fracture, may be due to residual confounding or effect modification in the latter study. " Get that, no increase of risk " in patients without major risk factors. " the increase found in another study may be because of " residual confounding or effect modification in the latter study. " In other words the increase may not have been because of PPIs but because of other things in the lives of the patients being studied and the way the data was analyzed. Conclusion 5 " Use of drugs that inhibit gastric acid is associated with an increased risk of hip fracture; however, this association was only found among persons with at least one other risk factor for hip fracture. Acid inhibition might therefore be associated with fracture risk in persons already at risk for osteoporosis, although other confounding cannot be excluded. " And from the body conclusion, " The mechanism for the association is unknown; although diminished calcium absorption from acid inhibition is an intuitive explanation supported by a small trial, it is not a proven mechanism. " Again the association is not stated to be a causal one, and it was " only found among persons with at least one other risk factor for hip fracture " and " other confounding cannot be excluded " and the " mechanism for the association is unknown " and diminished calcium absorption is " not a proven mechanism. " Conclusion 6 " Use of PPIs was not associated with hip fractures but was modestly associated with clinical spine, forearm or wrist, and total fractures. " Well there goes the fear about falling down and breaking a hip because of PPIs. And other fractures were only " modestly associated " with PPI use and not proven to be causally related. Conclusion 7 " The use of PPIs in older women, and perhaps older men with low calcium intake, may be associated with a modestly increased risk of nonspine fracture. " And from the body summary, " Along with previously published studies, this data suggests that PPIs may have unintended negative skeletal effects, although they are likely minor on the individual level. " No increase in spine fractures. There " may be associated with a modestly increased risk " of fracture. Note the words " may " and " modestly " In the body summary note " may have " not proven to have. The effects are " likely minor on the individual level. " So while the effect may show when looking at the data for thousands of patients it is unlikely to make a noticeable difference on an individual. Conclusion 8 " PPI use does not appear to be associated with either the presence of osteoporosis or accelerated BMD loss. The association between PPI use and hip fracture is probably related to factors independent of osteoporosis. " Get that? No apparent association with either osteoporosis or accelerated BMD loss. The association, which may not even be causal, is independent of them. This study was specificaly look at PPIs and BMD and osteoporosis. Summing up the conclusions, in them we hear about " apparent " associations, modest associations and effects that " may be " associated with PPI uses, and association only when there are other risk factors, and also about " confounding or effect modification " and unproven mechanism. We also heard about effects that are probably unnoticeable on the individual, minor effects, effects of limited or unknown clinical importance. Moving on the FDA summary from: http://www.fda.gov/Drugs/DrugSafety/PostmarketDrugSafetyInformationforPatientsan\ dProviders/ucm213206.htm > . Six reported an increased risk of fractures with the use of proton > pump inhibitors 1,2,3,5,6,7. > Two, 4 and 8, reported no increase, but 8 was not looking for it. Study 1 found only a small change in risk. Study 5 only found an increase in patients with another risk factor. Study 6 didn't find an increase in hip fractures and only a " modest " increase in spine, forearm or wrist, and total fractures. Study 7 only found a " modestly increased risk of nonspine fracture " > . Exposure to proton pump inhibitors ranged from a period of 1 to 12 > years, depending on the study. > . The emergence of fractures varied among studies; with one study > reporting an increase in fractures with use of proton pump inhibitors > in the previous year 2 and another study finding an increase after 5 > to 7 years of proton pump inhibitor use 3. > The point here is that the outcome is not consistent in the studies. > . The increased risk of fractures was primarily observed in older > individuals. > One of those other risk factors. > . Two studies reported an increase in fractures with higher doses of > proton pump inhibitors 2,5. > Which could be because of the higher dose or it could be because of the condition causing the need for the higher dose. > . Two studies reported an increase in fractures with longer duration > of use 2,3. > Again, is it the duration or the cause for the longer duration that makes for the increase in risk. > . One study did not find a relationship between proton pump inhibitor > use and fractures 4. This study limited the study population to those > without major risk factors for fracture. > I think this one is important. You have to suspect confounding in the other studies. Take a look now at what the FDA says about the meaning of these studies. This is from the same FDA page as the other info you quoted: ======= " Several study limitations, however, make understanding the clinical relevance of the reported findings difficult to determine. Administrative claims databases do not typically contain information on all potential factors that could influence the relationship between proton pump inhibitors use and fracture risk. These studies were not able to account for missing or incomplete information on family history of osteoporosis, smoking history, weight and height measurements, alcohol use, history of dietary and supplement use (calcium and vitamin D), OTC medication use, presence of digestive diseases, such as ulcers, reasons for proton pump inhibitor use, and recent history of immobility, dizziness, or falls. In addition, in most studies where a possible link with osteoporotic fracture was reported, no information was collected about the timing of proton pump inhibitor use in relation to onset or worsening of osteoporosis. " " However, the exact mechanisms for an increased risk of fractures with proton pump inhibitor use are not known. Three epidemiologic studies found no consistent association between chronic proton pump inhibitor use and bone mineral density 6,7,8. " " Based on the available data, at this time it is not clear if the use of proton pump inhibitors is the cause of the increased risk of fractures seen in some epidemiologic studies. " ======= You said, " I believe that PPI's over long time might also cause osteoporosis for older people, I have looked at the FDA report. Most of the reports say this is true except one. " I think what they report is that they found an association with increase fracture rates that may or may not be caused by PPIs and that the study, 8, designed to look at PPIs and BMD suggests that the association is not related to BMD and not related to osteoporosis. In any case the last sentence of the FDA quote above say it is not clear that any of this is because of PPIs. > Update: 3/23/2011 > FDA has determined an osteoporosis and fracture warning on the > over-the-counter (OTC) proton pump inhibitor (PPI) medication " Drug > Facts " label is not indicated at this time. > > Following a thorough review of available safety data, FDA has > concluded that fracture risk with short-term, low dose PPI use is > unlikely. > Right, the effect, which may not even be caused by PPIs, is associated with high doses and long-term use. There is a newer (2012) study out: Use of proton pump inhibitors and risk of hip fracture in relation to dietary and lifestyle factors: a prospective cohort study http://www.bmj.com/content/344/bmj.e372 It is interesting. " Participants 79 899 postmenopausal women enrolled in the Nurses' Health Study who provided data on the use of PPIs and other risk factors biennially since 2000 and were followed up to 1 June 2008. " It found that the increase in risk was only in those that smoked. Also they found that the rate of fractures was 20.2 incidents for 10,000 women on PPIs per year compared to 15.1 per 10,000 for non-users. As a personal risk I think that is small and I don't smoke anyway. notan Quote Link to comment Share on other sites More sharing options...
Guest guest Posted May 25, 2012 Report Share Posted May 25, 2012 Hi notan I really didnt think you would spend that amount of time. Anyway GREAT response. Now people can make up owns mind! I just wanted to let people know about this. I am not on PPI's anymore or anything, I just clean out the e so never have indigestion at night, that is if I really clean it out before bed time. Now I believe 5 years ago my LES was already closing or closed which caused the food to rot in the e, giving me indigestion. PS are you jogging now? Ray CA OC > > This is going to be long. > > > > > >However: if you are over 50 and drink a lot of colas the cola > > drinking may lead to a fracture. > > Yes this may also be true. Wonder if the FDA has issued a report on this. > > > > There are a number of crazy things that go on with food to which the FDA > is silent so I would read much into the silence. > > > > > My wife has osteoporosis at 81, she has never had PPI's or a cola, so > > I tell her don't fall or you will break a hip. It will happen to most > > of us. My brother at 85 fell off a curb and broke a leg, dont believe > > he was on PPI's, just getting old. > > > > Getting old is a much bigger problem for bones than PPIs. > > > > > I remember recently that notan fell and broke both feet/ankles/legs? I > > know he had a hard time with this. Not sure how it happened or just > > where the fracture was or what caused it. I hope you are now walking > > and maybe jogging. A report would be great. > > > > I fell about 10 ft onto concrete that was sloped and each foot landed at > a different hight and different slope. I am tall and big and I have > narrow ankles that have always been a problem and could not take that > much stress. I had a bone density scan one year before and my leg bones > had better density than a 30 year old man. Probably because I put so > much stress on my legs. On the other hand, my spine is not as dense as > it should be probably because I have a vitamin D problem and my spine > does not carry the stress that my legs do. My hips are normal for my > age. So, even with over 5 years of PPI use my legs were not weakened and > actually stronger than most people my age but my ankles and feet were > going to bust from that fall even if had never taken PPIs. > > > > > I believe that PPI's over long time might also cause osteoporosis for > > older people, I have looked at the FDA report. Most of the reports say > > this is true except one. > > > > True that they " might " cause an almost unnoticeable difference, yes, > " might " and very small effect. That it is proven true that they do, no, > it is not proven true and many doctors do not think the risk is > important. If there were a study that found sky divers were more likely > to have car accidents would that mean sky diving causes car accidents or > would it be simply an association of one action of thrill seeker sky > divers to an unrelated outcome of another action of thrill seekers. Sky > diving would be associated with a higher car accident risk but would not > be causal to the risk. In other words the real increase in risk is > because some sky divers are thrill seekers who drive faster. So, what I > see in the PPI studies is association not causation and if there is any > causation from the PPIs it is very low. The point here is to remember in > the rest of this discussion when they say that a study found an > association that is not the same as saying they know they have found or > proven the cause. Remember that word, " association. " > > > Went through all of the references, sort of hard to digest the > > summaries, so look at the following. > > > > I am going to number the studies and then deal with the rest of your > message. If you are not interested in the number skip down to the study > conclusions. > > Study 1 > Proton pump inhibitors, histamine H2 receptor antagonists, and other > antacid medications and the risk of fracture. > http://www.ncbi.nlm.nih.gov/pubmed/16927047 > > Study 2 > Long-term proton pump inhibitor therapy and risk of hip fracture. > http://www.ncbi.nlm.nih.gov/pubmed/17190895 > > Study 3 > Use of proton pump inhibitors and risk of osteoporosis-related fractures > http://www.cmaj.ca/content/179/4/319.abstract > > Study 4 > Proton pump inhibitor use and risk of hip fractures in patients without > major risk factors. > http://www.ncbi.nlm.nih.gov/pubmed/18657011 > > Study 5 > Proton Pump Inhibitors and Histamine-2 Receptor Antagonists are > Associated with Hip Fractures among At-Risk Patients > (Notice that word, " Associated. " ) > http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2902649/ > > Study 6 > Proton pump inhibitor use, hip fracture, and change in bone mineral > density in postmenopausal women: results from the Women's Health Initiative. > http://www.ncbi.nlm.nih.gov/pubmed/20458083 > > Study 7 > Acid-suppressive medications and risk of bone loss and fracture in older > adults. > http://www.ncbi.nlm.nih.gov/pubmed/18813868 > > Study 8 > Proton-pump inhibitor use is not associated with osteoporosis or > accelerated bone mineral density loss. > (Read that title again. And yes I know there could be another method.) > http://www.ncbi.nlm.nih.gov/pubmed/19931262 > > Now take a close look at the study conclusions from the abstracts. > Remember our word for the day is " association " in all its forms. > > Conclusion 1 > " Proton pump inhibitors appeared to be associated with a limited > increase in fracture risk, in contrast to histamine H( 2 ) antagonists, > which seemed to be associated with a small decrease in fracture risk. In > all cases, the changes in risk estimates were small and the clinical > significance was limited. " > > They say " appeared to be associated " not are causal to. Note also, > " limited increase " and " changes in risk estimates were small " and > " clinical significance was limited. " > > Conclusion 2 > " Long-term PPI therapy, particularly at high doses, is associated with > an increased risk of hip fracture. " > > Once again it is " associated with " not causal to. > > Conclusion 3 > " Interpretation: Use of proton pump inhibitors for 7 or more years is > associated with a significantly increased risk of an > osteoporosis-related fracture. There is an increased risk of hip > fracture after 5 or more years exposure. Further study is required to > determine the clinical importance of this finding and to determine the > value of osteoprotective medications for patients with long-term use of > proton pump inhibitors. " > > Nowhere do they say there is a causal relationship but they do use the > word " associated. " They also imply they don't know what the clinical > importance of the finding is. It may not be important or it may not be > of importance to PPIs. > > Conclusion 4 > " Use of PPIs does not increase the risk of hip fracture in patients > without major risk factors. The difference in results between our study > and that of another, which indicated that PPI use increases the risk of > hip fracture, may be due to residual confounding or effect modification > in the latter study. " > > Get that, no increase of risk " in patients without major risk factors. " > the increase found in another study may be because of " residual > confounding or effect modification in the latter study. " In other words > the increase may not have been because of PPIs but because of other > things in the lives of the patients being studied and the way the data > was analyzed. > > Conclusion 5 > " Use of drugs that inhibit gastric acid is associated with an increased > risk of hip fracture; however, this association was only found among > persons with at least one other risk factor for hip fracture. Acid > inhibition might therefore be associated with fracture risk in persons > already at risk for osteoporosis, although other confounding cannot be > excluded. " And from the body conclusion, " The mechanism for the > association is unknown; although diminished calcium absorption from acid > inhibition is an intuitive explanation supported by a small trial, it is > not a proven mechanism. " > > Again the association is not stated to be a causal one, and it was " only > found among persons with at least one other risk factor for hip > fracture " and " other confounding cannot be excluded " and the " mechanism > for the association is unknown " and diminished calcium absorption is > " not a proven mechanism. " > > Conclusion 6 > " Use of PPIs was not associated with hip fractures but was modestly > associated with clinical spine, forearm or wrist, and total fractures. " > > Well there goes the fear about falling down and breaking a hip because > of PPIs. And other fractures were only " modestly associated " with PPI > use and not proven to be causally related. > > Conclusion 7 > " The use of PPIs in older women, and perhaps older men with low calcium > intake, may be associated with a modestly increased risk of nonspine > fracture. " And from the body summary, " Along with previously published > studies, this data suggests that PPIs may have unintended negative > skeletal effects, although they are likely minor on the individual level. " > > No increase in spine fractures. There " may be associated with a modestly > increased risk " of fracture. Note the words " may " and " modestly " In the > body summary note " may have " not proven to have. The effects are " likely > minor on the individual level. " So while the effect may show when > looking at the data for thousands of patients it is unlikely to make a > noticeable difference on an individual. > > Conclusion 8 > " PPI use does not appear to be associated with either the presence of > osteoporosis or accelerated BMD loss. The association between PPI use > and hip fracture is probably related to factors independent of > osteoporosis. " > > Get that? No apparent association with either osteoporosis or > accelerated BMD loss. The association, which may not even be causal, is > independent of them. This study was specificaly look at PPIs and BMD and > osteoporosis. > > Summing up the conclusions, in them we hear about " apparent " > associations, modest associations and effects that " may be " associated > with PPI uses, and association only when there are other risk factors, > and also about " confounding or effect modification " and unproven > mechanism. We also heard about effects that are probably unnoticeable on > the individual, minor effects, effects of limited or unknown clinical > importance. > > Moving on the FDA summary from: > http://www.fda.gov/Drugs/DrugSafety/PostmarketDrugSafetyInformationforPatientsan\ dProviders/ucm213206.htm > > > . Six reported an increased risk of fractures with the use of proton > > pump inhibitors 1,2,3,5,6,7. > > > > Two, 4 and 8, reported no increase, but 8 was not looking for it. Study > 1 found only a small change in risk. Study 5 only found an increase in > patients with another risk factor. Study 6 didn't find an increase in > hip fractures and only a " modest " increase in spine, forearm or wrist, > and total fractures. Study 7 only found a " modestly increased risk of > nonspine fracture " > > > . Exposure to proton pump inhibitors ranged from a period of 1 to 12 > > years, depending on the study. > > . The emergence of fractures varied among studies; with one study > > reporting an increase in fractures with use of proton pump inhibitors > > in the previous year 2 and another study finding an increase after 5 > > to 7 years of proton pump inhibitor use 3. > > > > The point here is that the outcome is not consistent in the studies. > > > . The increased risk of fractures was primarily observed in older > > individuals. > > > > One of those other risk factors. > > > . Two studies reported an increase in fractures with higher doses of > > proton pump inhibitors 2,5. > > > > Which could be because of the higher dose or it could be because of the > condition causing the need for the higher dose. > > > . Two studies reported an increase in fractures with longer duration > > of use 2,3. > > > > Again, is it the duration or the cause for the longer duration that > makes for the increase in risk. > > > . One study did not find a relationship between proton pump inhibitor > > use and fractures 4. This study limited the study population to those > > without major risk factors for fracture. > > > > I think this one is important. You have to suspect confounding in the > other studies. > > Take a look now at what the FDA says about the meaning of these studies. > This is from the same FDA page as the other info you quoted: > ======= > " Several study limitations, however, make understanding the clinical > relevance of the reported findings difficult to determine. > Administrative claims databases do not typically contain information on > all potential factors that could influence the relationship between > proton pump inhibitors use and fracture risk. These studies were not > able to account for missing or incomplete information on family history > of osteoporosis, smoking history, weight and height measurements, > alcohol use, history of dietary and supplement use (calcium and vitamin > D), OTC medication use, presence of digestive diseases, such as ulcers, > reasons for proton pump inhibitor use, and recent history of immobility, > dizziness, or falls. In addition, in most studies where a possible link > with osteoporotic fracture was reported, no information was collected > about the timing of proton pump inhibitor use in relation to onset or > worsening of osteoporosis. " > > " However, the exact mechanisms for an increased risk of fractures with > proton pump inhibitor use are not known. Three epidemiologic studies > found no consistent association between chronic proton pump inhibitor > use and bone mineral density 6,7,8. " > > " Based on the available data, at this time it is not clear if the use of > proton pump inhibitors is the cause of the increased risk of fractures > seen in some epidemiologic studies. " > ======= > > You said, " I believe that PPI's over long time might also cause > osteoporosis for older people, I have looked at the FDA report. Most of > the reports say this is true except one. " > > I think what they report is that they found an association with increase > fracture rates that may or may not be caused by PPIs and that the study, > 8, designed to look at PPIs and BMD suggests that the association is not > related to BMD and not related to osteoporosis. In any case the last > sentence of the FDA quote above say it is not clear that any of this is > because of PPIs. > > > Update: 3/23/2011 > > FDA has determined an osteoporosis and fracture warning on the > > over-the-counter (OTC) proton pump inhibitor (PPI) medication " Drug > > Facts " label is not indicated at this time. > > > > Following a thorough review of available safety data, FDA has > > concluded that fracture risk with short-term, low dose PPI use is > > unlikely. > > > > Right, the effect, which may not even be caused by PPIs, is associated > with high doses and long-term use. > > There is a newer (2012) study out: > Use of proton pump inhibitors and risk of hip fracture in relation to > dietary and lifestyle factors: a prospective cohort study > http://www.bmj.com/content/344/bmj.e372 > > It is interesting. " Participants 79 899 postmenopausal women enrolled in > the Nurses' Health Study who provided data on the use of PPIs and other > risk factors biennially since 2000 and were followed up to 1 June 2008. " > It found that the increase in risk was only in those that smoked. Also > they found that the rate of fractures was 20.2 incidents for 10,000 > women on PPIs per year compared to 15.1 per 10,000 for non-users. As a > personal risk I think that is small and I don't smoke anyway. > > notan > > > > > Quote Link to comment Share on other sites More sharing options...
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