Medslant Acid Reflux Newsletter

PPI's and Osteoporosis

New research keeps surfacing that suggests that both doctors and patients should not get complacent about prescription or OTC proton pump inhibitors' particularly for long term use. The first warning appeared in January, 2007, when Dr. Yu-Xiao of the University Of Pennsylvania School Of Medicine cautioned that that one needed an excellent reason for long term PPI use. His study, based on more than 145,000 participants showed that more than one year of PPI use increased hip fracture risk by 44% in people 50 and older. Many physicians now agree. Conservative estimates are that more than 20% of the Western population suffers acid reflux at least once a week and we are spending big bucks - $25.6 billion in 2008' on drugs to alleviate the symptoms.

John Clarke, MD, assistant professor of medicine and director of esophageal motility at Johns Hopkins University has concerns. When you take PPIs and decrease your gastric acid, you absorb less calcium. Gastric acid helps cleave calcium from food and suppression of gastric acid may lead to malabsorption. Research has proven that fracture rates correspond to both length of time on PPIs and dose. And it is not just middle aged patients who need be concerned. Patients in their 20s and 30s who take PPIs need to consider their bone density later. Dr. Clarke suggests limiting the use of PPIs to a finite period of time. If long term use is necessary, then, he cautions that you must be proactive in addressing issues of bone density and take meds if necessary.

The best suggestion as always is to consult your physician or health care professional about your personal needs. You need to be in charge of your current and future health.

PPI's May Cause Rebound Symptoms

An article published in this month's journal, Gastroenterology, cites the results of a study that claim that PPI's may actually cause or aggravate the acid reflux symptoms they are designed to treat. Two months after taking Nexium, 44% of healthy volunteers who began the study with no reflux symptoms, developed significant heartburn, compared with 15% who took a placebo. Christina Reimer, MD, of Copenhagen University in Denmark the lead researcher, says that it has been documented for years that long term PPI use induces a temporary increase in the secretion of acid. The theory is that lowered stomach acid levels caused by the action of the drugs causes the body to compensate by secreting even more acid into the stomach. Researchers are not sure how long this rebound effect continues but believe it is somewhere between four and twelve weeks. The primary suggestion is to discuss your personal case with the prescribing physician to make sure you really need the drug and not to just continue taking it if not absolutely necessary.

Pediatric Dental Erosion and GERD

It has long been established that many adults are diagnosed with GERD by their dentists' acid has eroded their dental enamel. At a recent meeting of the Pediatric Academic Societies annual meeting, new research confirmed that children with chronic reflux are much more likely to have dental erosion than those without reflux. The study's senior author, Melvin Heyman MD, chief of pediatric gastroenterology, hepatology and nutrition, University of California, San Francisco Children's Hospital, reports that pediatricians and dentists worked together to investigate the teeth of 80 children aged 9' 17. An additional 20 children served as a control group. The patients with GERD were six times more likely to have dental erosion. About 22% of the pediatric population has GERD and the disease appears to be on the rise.

Symptoms may include coughing, asthma, chest pain, and dental erosion. Erosion weakens the dental enamel and leaves the dentin' the principal mass of a tooth below the enamel' exposed. Children have thinner enamel and dentin layers than adults so they are at increased risk for erosion. This erosion can lead to a permanent weakening of the teeth, increased decay and a need for major dental work.

Solution suggestions are varied and Dr. Heyman says the easiest thing to do for kids with GERD is to have them make lifestyle changes. Obesity is a major risk for GERD as is extra abdominal weight. Other lifestyle changes like figuring out and avoiding trigger foods are important as is sleeping elevated. Chewing sugarless gum seems to help just as in adults; it keeps saliva flowing down the esophagus.

The important thing is that pediatricians and dentists work together in prescribing a course of action.

Please keep the phone calls and emails coming to 1.800.346.1850 and customerservice@medslant.com. I love hearing from you.

A Good Night's Sleep is taking an August vacation' we'll be back in September.

Have a safe, fun, and hopefully reflux free summer.

Wishing you a good night's sleep,



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