Holiday revelers beware: Seasonal indulgences
like eggnog and fruitcake might give you heartburn, but
the acid-fighting medicine you take for relief might lead
to something worse, researchers say.
People
on popular prescription heartburn drugs -- Prilosec, Prevacid
and Nexium -- seem more prone to getting a potentially
dangerous diarrhea caused by the bug Clostridium difficile,
new research shows. C-diff, as it's known, can cause severe
diarrhea and crampy intestinal inflammation called colitis.
Dr. Sandra
Dial and colleagues at McGill University in Montreal examined
data on more than 18,000 patients in the United Kingdom
from 1994 to 2004. During that time, 1,672 cases of C-diff
were diagnosed, and the numbers increased from less than
1 per 100,000 in 1994 to 22 per 100,000 last year.
Patients with prescriptions for powerful acid-fighters
called proton pump inhibitors, which include Prilosec
and Prevacid, were almost three times more likely to be
diagnosed with the bug than those not taking the drugs.
Those on less potent prescription drugs called H2 receptor
antagonists, which include Pepcid and Zantac, were two
times more likely than nonusers to get C-diff infections.
The widely
used and heavily promoted drugs reduce levels of gastric
acid that can keep C-diff germs at bay.
Dr. L.
Clifford McDonald, a researcher at the federal Centers
for Disease Control and Prevention, said proton pump inhibitors
recently were implicated in a C-diff outbreak at a hospital
and nursing homes in Maine.
"It's
not surprising in my mind that there could be some association"
with acid-fighting drugs, said McDonald, who was not involved
in Dial's study. If there is, I do think it would be very
important because, boy, everyone and their brother seems
to be on them.
Most study
patients hadn't been recently hospitalized and weren't
taking antibiotics, which both can increase risks for
C-difficile infections.
Also,
most patients hadn't been diagnosed with ulcers or acid
reflux, so it's possible many simply had heartburn, Dial
said.
"Heartburn
in and of itself isn't dangerous," and can often
be treated with less potent drugs, Dial said.
Her study
appears in Wednesday's Journal of the American Medical
Association.
A co-author
is a consultant for AstraZeneca PLC, which markets Prilosec
and Nexium, and Altana Pharma, which makes and markets
another prescription heartburn drug, Protonix, in Europe.
A spokesman for Wyeth, which markets Protonix in the United
States, said the company hadn't seen the research and
declined comment.
AstraZeneca
spokeswoman Cindy Callaghan said patient safety is the
company's top priority and that the findings are not the
final word.
Further
research is needed in this particular area to determine
the validity of a potential link, she said.
C-diff
bacteria historically have been found in patients on antibiotics
or with underlying illnesses, especially those in hospitals
or nursing homes, but infections increasingly have been
reported in the community.
Doctors
think the growing trend is due in part to overuse of antibiotics
but the new data suggest overuse of acid-fighting drugs
may be another reason, said Dr. Michael Brown, a gastroenterologist
at Rush University Medical Center in Chicago, who was
not involved in the study.
The drugs
are popular because they are so effective at fighting
stomach acid, and are generally very safe, Brown said.
Brown
said short-term use of potent acid-fighting drugs for
occasional over-imbibing is unlikely to increase infection
risks in otherwise healthy people, but that the results
suggest doctors and patients have to think twice about
using such heavy acid suppression over the long term.
