Heartburn (GERD) Drugs: A New Caution (cont.)

MEMBER QUESTION:
So does this happen only when you lie down?

PEIKIN:
It's not clear. Certainly when you lie down you increase the chance of stomach contents refluxing back into the esophagus, and this could make it easier for bacteria to translocate from the stomach to the respiratory tract. If you do have reflux symptoms and you're on acid blocking medication, you should keep the head of your bed elevated at bedtime.

MEMBER QUESTION:
When you have HIV what are the risks for developing pneumonia during heartburn treatment? Is it better to stop the drug to stop the possibility of developing pneumonia, since HIV makes it easier to get pneumonia?

PEIKIN:
The answer is not known; this study did not address that. I would say that if you have a definite indication or need for acid blocking medicine, that I would take it even if you have HIV, which already predisposes you to high risk of pneumonia. On the other hand, high-risk patients, such as you or those people with emphysema who feel they can safely go off acid blocking medicine, can do so.

MEMBER QUESTION:
I have severe asthma and reflux. I heard that this was a special problem for asthmatics. What am I supposed to do now?

PEIKIN:
In some studies, up to 80 percent of asthma patients have gastroesophageal reflux. This acid reflux can certainly make their asthma symptoms worse. If an asthma patient is taking acid blocking medication, such as Protonix or Nexium, and it is helping their asthma, then I would not stop it. If, on the other hand, after three to six months of treatment with acid blocking medicine there was no perceived benefit in asthma symptoms, I probably would stop the medicine.

"I think there's a greater danger of people stopping their medication because of fear of pneumonia than the actual extremely small risk of ever getting pneumonia due to an acid blocking drug."

MODERATOR :
For those who are dealing with GERD and may want to help themselves, what should they do in terms of diet and lifestyle?

PEIKIN:
In my book, Gastrointestinal Health, I outline extensive non-drug treatments for gastroesophageal reflux. Certain dietary restrictions, such as:
  • Avoiding greasy foods
  • Avoiding peppermint
  • Avoiding chocolate
  • Avoiding nuts
  • Avoiding caffeine-containing beverages
  • Elevating the head of the bed
  • Not eating for at least three hours before lying down

MEMBER QUESTION:
What do you do if you think you might be getting sick? How different is pneumonia from the flu, as far as symptoms go? Should patients on heartburn meds call the doctor at the first sign of feeling sick?

PEIKIN:
Basically symptoms of pneumonia include fever and cough productive of puss sputum. You may also have shortness of breath. Certainly, if you develop those symptoms, whether or not you're on acid blocking medication, you need to see your doctor. People will develop common cold symptoms several times a year. This has nothing to do with acid blocking medicine.

MEMBER QUESTION:
What are the drug companies saying in response to this?

PEIKIN:
I don't know what the drug companies are going to say, but if I were working for a drug company I certainly would feel comfortable trying to ease the general population's worry about developing pneumonia while on acid blocking medication.

I think there's a greater danger of people stopping their medication because of fear of pneumonia than the actual extremely small risk of ever getting pneumonia due to an acid blocking drug. I do not think this study should significantly change the way doctors treat their patients who have acid-related disease.

We do know, however, there are a lot of people who continue to take this type of medication even though they may not actually require it. If that is the case, then doctors should take their patients off any medication that is really not necessary.

Overall, the H2 blockers and proton pump inhibitors, drugs that block acid, remain some of the safest drugs we have. The biggest issue related to this article is how to prevent doctors and patients from overreacting to the article.

MODERATOR :
Our thanks to Steven Peikin, MD, for joining us. For more information on all kinds of gastro-related health issues, read Gastrointestinal Health, a book by our guest, Steven R. Peikin, MD. And be sure to visit the WebMD message boards to ask questions of our online health professionals and to share questions, comments, and support with other WebMD members.



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