Heartburn Drugs: A New Caution
WebMD Live Events Transcript
A recent study revealed that the use of gastric-acid suppressive drugs is linked to an increased risk of pneumonia. What is the connection, and what are experts advising in the wake of this news? Are you at risk? Gastroenterologist Steven Peikin, MD, joined us on October 28, 2004, to explain the new study and answer your questions.
The opinions expressed herein are the guests' alone and have not been reviewed by a WebMD physician. If you have questions about your health, you should consult your personal physician. This event is meant for informational purposes only.
There are a lot of heartburn treatments out there. Does this study warn about just a certain kind?
All heartburn treatments that work by inhibiting acid or neutralizing acid may potentially increase the risk of pneumonia. The stronger the acid-suppressing drug, the higher the risk. So drugs like Nexium, especially if they're given more than once a day, or any of the other proton pump inhibitors, such as Protonix, Aciphex, Prevacid, or Prilosec, would be expected to be higher risk than H2 blocker drugs, such as Zantac. In fact, there was no definite risk associated with some of the H2 blockers, such as Pepcid or Tagamet.
The risk of developing pneumonia during treatment for heartburn still remains extremely small. When you take a drug, you and your doctor always need to weigh the risks of the drug against its potential benefits. For most heartburn sufferers, and for most people who are trying to prevent complications of arthritis medicine by taking drugs that inhibit acid, the risks of stopping the drug are probably greater than the small risk of developing pneumonia. I believe that people should not overreact to this article.
Do Tums have any ingredients that can be a conduit for pneumonia?
Although this study did not study antacids to any extent, it certainly is possible that antacids could also carry with them a risk of developing pneumonia. In 1987, a study was published in the New England Journal of Medicine showing that ICU patients who received antacids to prevent stress ulcers had a higher risk of developing pneumonia. Again, the risk appears to be extremely small.
How do these drugs increase the risk for pneumonia?
The mechanism appears to be that the suppression of acid in the stomach allows bacteria that are not normally in the stomach to grow. Acid prevents the growth of bacteria. If you block the acid it is possible for bacteria to grow in the stomach. If you lie down at night, you may reflux stomach contents back up into your esophagus, and with it some bacteria, which can then find their way into the respiratory tract in the back of the throat.
One potential criticism of the study was that most of the people who take these drugs take them for heartburn caused by stomach contents refluxing back into the esophagus. It could be that gastroesophageal reflux itself causes aspiration-induced pneumonia. The people who require the highest doses of acid inhibiting medicines for their reflux are those who have the worst reflux, and therefore may be more prone to develop pneumonia.