Proton pump inhibitors the most effective in preventing GERD
By Paul G. Donohue, M.D.
DEAR DR. DONOHUE: Is it true that those of us who have to take Prilosec every day are in danger of getting a bone fracture? Should we consider stopping it? – Anonymous
ANSWER: We need to give readers a clue to what we’re talking about. The subject is GERD, gastroesophageal reflux disease, something most call “heartburn.” It’s the eruption of stomach acid and digestive juices into the esophagus, a place not built to withstand those powerful fluids.
Proton-pump inhibitors are the most effective suppressants of acid production. There are eight: Prilosec (omeprazole), Nexium (esomeprazole), Prevacid (lansoprazole), Dexilant (dexlansoprazole), Protonix (pantoprazole) and Aciphex (rabeprazole). These medicines have made life livable for people who don’t respond to other strategies or medicines for heartburn control.
All effective medicines have side effects. A side effect of proton-pump inhibitors is weakening of the hip bone with possible fracture of it. It’s not a common occurrence. When it happens, it happens to those who have taken high doses of these medicines for five to seven years. As a preventive step, take a proton-pump inhibitor at the lowest dose that controls symptoms and for the shortest time possible. You can resume taking it if and when heartburn returns.
You also can try acid suppressants that don’t have this side effect: Tums, Rolaids and Maalox. Don’t eat foods that cause you to have heartburn. Frequent offenders are excessive amounts of caffeine, chocolate, alcohol, peppermint, fatty foods, citrus fruits and tomatoes. Or try a different family of acid suppressants. Zantac (ranitidine), Pepcid (famotidine) and Tagamet (cimetidine) are examples.
I wouldn’t use the unapproved treatment mentioned in the letter you sent. It appears that its distributor is playing on exaggerated fear.
The booklet on heartburn explains this illness and its treatment in detail. Readers can order a copy by writing: Dr. Donohue, No. 501W, Box 536475, Orlando, FL 32853-6475. Enclose a check or money order (no cash) for $4.75 U.S./$6 Canada with the recipient’s printed name and address. Please allow four weeks for delivery.
DEAR DR. DONOHUE: I am a 90-year-old senior in good health. I belong to an HMO. During my annual physical, I told the doctor I had some hemorrhoids. He insisted I get a colonoscopy. My family is ready to kill him for recommending this for someone 90 years-old. I have refused the colonoscopy and received a letter stating that I would be responsible for any bills if I ever have a problem. Should I have this procedure? – H.L.
ANSWER: The U.S. Preventive Services Task Force, a committee of recognized authorities, says people can stop having colonoscopies at age 75 if previous colonoscopies have been normal. It also says that people older than 85 should not be routinely advised to have a colonoscopy, because the danger of colon perforation during the exam is greater than their risk of dying from cancer. However, if older people have a life expectancy of 10 years and want to be screened, their wishes should be honored.
Ask your doctor about other ways of detecting colon cancer. The fecal immunochemical test for blood is an example. Your stance is not unreasonable.
Dr. Donohue regrets that he is unable to answer individual letters, but he will incorporate them in his column whenever possible. Readers may write him or request an order form of available health newsletters at P.O. Box 536475, Orlando, FL 32853-6475.
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