Medslant Acid Reflux Newsletter

PPI's and Plavix

Last April I told you about several studies that expressed concern about the combination of PPI's and Plavix. Plavix is a clot-preventing blood thinner typically given to patients after receiving a stent in a coronary artery opening procedure. It helps reduce the risk of another heart attack after treatment for a first attack and makes blood platelets less sticky so as to help prevent clots from forming. PPI's are given to patients to help prevent reflux and gastrointestinal bleeding. Many patients are being prescribed proton pump inhibitors prophylactically to prevent a stomach bleed. P. Michael Ho MD, a cardiologist at the Denver VA Medical Center and Gregg C. Fonarrow, MD, professor of cardiology at the University of California, Los Angeles, both cautioned that taking Plavix and PPI's together should be an individualized decision involving both patient and physician. The results of these studies were published in the Journal of the American Medical Association March 4, 2009 issue. In January, researchers reported in the Canadian Medical Association Journal that patients taking both meds after a heart attack had a dramatically higher risk of a second heart attack than those taking Plavix alone. Steven Nissen, MD, chief of cardiovascular medicine at the Cleveland Clinic said the risk is a concern. "When you have an interaction where one drug actually blocks the effectiveness of another drug that treats a serious disorder, you've got to take that seriously."

Plavix, manufactured by Bristol-Myers Squibb is the world's second biggest-selling drug with worldwide sales of approximately $9 billion; Nexium, manufactured by AstraZeneca had sales of approximately $5 billion n 2008.

Now, for the good news. New findings seems to contradict the above studies and say that patients taking Plavix may also safely take a PPI. Lead researcher of a study published in The Lancet medical journal in early September, Michelle L. O'Donoghue, MD of Boston's Brigham and Women's Hospital said, "We did not find use of a PPI to be associated with a higher risk of cardiovascular events for patients taking either of these drugs." Two trials were conducted, the larger of which included more than 13,000 patients. Dr. O'Donoghue continues that the current findings "provide some reassurance to clinicians that PPIs and anti clotting drugs can be safely combined in patients for whom there is a strong indication to use both drugs". Timothy J. Gardner, MD, immediate past president of the American Heart Association says more study is necessary to fully understand the impact of PPIs on Plavix in heart patients.

As always, the best advice is to consult your physician to determine what is the best health care program for you.

Sleeping Aids and Reflux Disease

If you have GERD, particularly nocturnal GERD, sleeping pills may not be good medical care for you. An article published in the September, 2009, Clinical Gastroenterology and Hepatology reported that certain sleep aids increased the duration of acid reflux events in healthy patients with GERD and reduced the arousal response to nocturnal reflux events. The study lead author, Anhony J. DiMarino Jr., MD of Thomas Jefferson University, Philadelphia, PA said that as many as one third of patients with disturbed sleep may have undiagnosed GERD and that "If the effect of blunted arousals or awakenings by sleep aids is substantiated, this would suggest caution in the use of sleep aids without first considering GERD as a cause in patients with complaints of disturbed sleep." The study was small but did suggest that sleep aid use by GERD patients could lead to complications for the disease. Once again, make sure you check with your physician or health care professional.

Digestive Health Tips

The American College of Gastroenterology has some tips on swallowing and heartburn. Abnormal swallowing or that feeling of food "sticking on the way down" can be serious. If it is a condition that persists, it should be checked by a medical professional. Swallowing difficulty may be caused by many problems including but not limited to infection, incomplete chewing, eating too quickly, abnormal muscle contractions and more. Heartburn is a common problem that is a symptom of GERD, not a disease. It can often be helped by maintaining a healthy weight, quitting smoking, identifying and avoiding your trigger foods, avoiding certain medications, not wearing clothes that constrict the abdomen, sleeping elevated, and not lying down for several hours after eating. Most important, before attributing any kind of chest pain that happens more than twice a week to GERD, you should check it out to be sure it is not heart related.

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