Tag: proton pump inhibitors

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Acid-lowering Meds Linked to Greater Risk of Migraines

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People who take acid-reducing drugs may have a higher risk of migraine and other severe headache than people who do not take these medications, a new study has shown. The acid-reducing drugs include proton pump inhibitors such as omeprazole and esomeprazole, histamine H2-receptor antagonists, or H2 blockers, such as cimetidine and famotidine, and antacid supplements.

The study, study published in Neurology®Clinical Practice, an official journal of the American Academy of Neurology, does not prove causation; only an association.

In acid reflux, stomach acid flows into the oesophagus, usually after a meal or when lying down, causing heartburn and ulcers. People with frequent acid reflux may develop gastroesophageal reflux disease, or GORD, which can lead to cancer of the oesophagus.

“Given the wide usage of acid-reducing drugs and these potential implications with migraine, these results warrant further investigation,” said study author Margaret Slavin, PhD, RDN, of the University of Maryland in College Park. “These drugs are often considered to be overprescribed, and new research has shown other risks tied to long-term use of proton pump inhibitors, such as an increased risk of dementia.”

For the study, researchers looked at data on 11,818 people who provided information on use of acid-reducing drugs and whether they had migraine or severe headache in the past three months.

A total of 25% of participants taking proton pump inhibitors had migraine or severe headache, compared to 19% of those who were not taking the drugs. A total of 25% of those taking H2 blockers had severe headache, compared to 20% of those who were not taking those drugs. And 22% of those taking antacid supplements had severe headache, compared to 20% of those not taking antacids.

When researchers adjusted for other factors that could affect the risk of migraine, such as age, sex and use of caffeine and alcohol, they found that people taking proton pump inhibitors were 70% more likely to have migraine than people not taking proton pump inhibitors. Those taking H2 blockers were 40% more likely and those taking antacid supplements were 30% more likely.

“It’s important to note that many people do need acid-reducing medications to manage acid reflux or other conditions, and people with migraine or severe headache who are taking these drugs or supplements should talk with their doctors about whether they should continue,” Slavin said.

Slavin noted that the study looked only at prescription drugs. Some of the drugs became available for over-the-counter use at non-prescription strength during the study period, but use of these over-the-counter drugs was not included in this study.

Other studies have shown that people with gastrointestinal conditions may be more likely to have migraine, but Slavin said that relationship is not likely to fully explain the tie between acid-reducing drugs and migraine found in the study.

A limitation of the study is that a small number of people were taking the drugs, especially the H2 blockers.

Source: American Academy of Neurology

Categories : GastrointestinalTags :

Deprescribing Efforts Shows that PPI Risks are Less than Expected

On By ModernMedia
Photo by Towfiqu Barbhuiya on Unsplash

Whether it’s costs, safety risks or “pill fatigue” they’re trying to reduce, many health systems and clinics have started working on ways to encourage deprescribing of medications that patients may not need. Now, a new study published in the BMJ shows the potential promise, and pitfalls, of a massive effort to reduce overuse of proton pump inhibitors (PPIs), widely prescribed for heartburn.

The findings also reveal that some of the feared risks from PPIs may be overblown.

The U.S. study tracks the impact of an intervention that imposed limits on PPI prescription size and refills for patients without a documented reason to be on the medication, discontinued old prescriptions, and provided education to patients and clinicians on alternatives.

The effort was carried out in one region of the Veterans Health Administration system, called VISN 17, and involved a quarter of a million patients, making it one of the largest ever studies on deprescribing.

Key findings

In all, the intervention led to a massive reduction in PPI use: a nearly 30% reduction in prescriptions of PPIs compared to other VA regions.

But the drive to reduce potentially unnecessary PPI use had one unintended consequence: a drop in prescribing to veterans who actually have an ongoing need to take PPIs because their other medicines carry a high risk of gastrointestinal bleeding. Strong evidence shows that PPIs are effective for preventing gastrointestinal bleeding and they are recommended in clinical guidelines.

Reassuringly, no matter the reason for taking PPIs, the deprescribing effort didn’t lead to increases in health care visits with gastrointestinal diagnoses. Nor did it lead to increases in gastrointestinal bleeding in patients at high risk, which suggests that the deprescribing initiative itself was safe.

Interestingly, the rate of purported negative PPI effects, such as kidney disease, stroke, heart attack or pneumonia, didn’t go down in VISN17 relative to the other regions. Hip fractures, another risk linked with PPIs in past studies, only went down by a small percentage.

This supports evidence from other high-quality studies that suggest PPIs may be a marker of patients at risk for certain adverse outcomes, but that the drugs are unlikely to be the cause.

For this reason, the main benefits to deprescribing PPIs have more to do with cost and hassle of taking more pills than clinical risk reduction.

More about the study

The new VA-funded study uses data from multiple years before and after VISN 17 implemented its PPI deprescribing program for most veterans living in Texas, and parts of New Mexico and Oklahoma.

It was led by a multi-institutional team that includes investigators from University of Michigan and the VA Center for Clinical Management Research (CCMR) in Ann Arbor; the University of Pennsylvania and the VA Center for Health Equity Research and Promotion (CHERP) in Philadelphia; and the Yale School of Medicine and VA Center for Pain Research, Informatics, Multi-morbidities, and Education (PRIME).

“This intervention worked so well because it was involuntary to some degree – refills could no longer be on autopilot for patients without a clear indication for the medication,” says Jacob Kurlander, MD, MS, first author of the study and a gastroenterologist at Michigan Medicine, U-M’s academic medical center, and the Lieutenant Colonel Charles S. Kettles VA Ann Arbor Medical Center. “At the same time, what we saw is that is that patients who benefit from PPIs for bleeding prevention – which is sometimes overlooked by doctors – got swept up in this effort, too.”

This signals that deprescribing efforts need to take even more care to ensure providers don’t allow a patient who has a need for the drug to inadvertently go off it, Kurlander said.

“Our findings also suggest that PPIs may not be as harmful as some have feared,” he adds.

Before the VISN 17 program started, about 26% of veterans across the country who got their primary care from a VA provider were prescribed a PPI in a six-month period.

By the end of the study period in 2019, only about 15% of veterans in VISN 17 had a PPI prescription, compared with about 22% of those in the other regions.

This means PPI prescribing dropped by 30% within VISN 17, and that there was more than a 7% absolute reduction in PPI use between VISN 17 and other regions by the end of the study period.

The researchers even connected veterans’ VA records with their Medicare data in case they received care outside the VA, and also used information from death certificates to look for causes of cardiovascular-related death. There were no differences between VISN 17 and the other regions.

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Turmeric as Effective as Omeprazole for Treating Dyspepsia, Comparative Study Suggests

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A natural compound found in the culinary spice turmeric may be as effective as the proton pump inhibitor (PPI) omeprazole for treating indigestion symptoms, suggests the first study of its kind, published online in the journal BMJ Evidence-Based Medicine.

Turmeric is derived from the root of the Curcuma longa plant. The spice contains a naturally active compound called curcumin thought to have anti-inflammatory and antimicrobial properties, and has long been used as a medicinal remedy, including for the treatment of indigestion, in South East Asia. 

But it’s not clear how well it compares with conventional drugs for this indication, largely because there have been no head to head studies.

The researchers therefore randomly assigned 206 patients aged 18–70 with recurrent upset stomach (functional dyspepsia) of unknown cause, recruited from hospitals in Thailand between 2019 and 2021, to one of three treatment groups for a period of 28 days.

These were: turmeric (two large 250mg capsules of curcumin 4 times a day) and one small dummy capsule; omeprazole (one small 20mg capsule daily and two large dummy capsules 4 times a day; and turmeric plus omeprazole.

PPIs such as omeprazole are used to treat functional dyspepsia, the symptoms of which include postprandial fullness, early satiety, and pain and/or epigastric pain.

But long term use of PPIs has been linked to increased fracture risk, micronutrient deficiencies, and a heightened risk of infections, note the researchers.

Of the 206 patients enrolled, 151 completed the study, with 20 in the curcumin group;19 in the omeprazole group; and 16 in the combined treatment group, dropping out. 

Patients in all three groups had similar clinical characteristics and indigestion scores, as assessed by the Severity of Dyspepsia Assessment score or SODA, at the start of the trial. Patients were reassessed after 28 days and then again after 56 days.

SODA scores indicated significant reductions in symptom severity by day 28 for pain (−4.83, –5.46 and −6.22) and other symptoms (−2.22, –2.32, and −2.31) for those in the combined, curcumin alone, and omeprazole alone groups, respectively. 

These improvements were even stronger after 56 days for pain (−7.19, –8.07 and −8.85, respectively) and other symptoms (−4.09, –4.12 and −3.71, respectively). 

SODA also captures satisfaction scores: these scarcely changed over time among the curcumin users, which might possibly be related to its taste and/or smell, suggest the researchers.

No serious side effects were reported, although liver function tests indicated some level of deterioration among curcumin users carrying excess weight, note the researchers.

They acknowledge the small size of the study, as well as several other limitations, including the short intervention period and lack of long-term monitoring data. Further larger, long term studies are needed, they say.

Nevertheless, they conclude: “This multicentre randomised controlled trial provides highly reliable evidence for the treatment of functional dyspepsia,” adding that “the new findings from our study may justify considering curcumin in clinical practice.”

Source: EurekAlert!

Categories : Gastrointestinal NeurologyTags : Leave a comment

Possible Dementia Risk from Long Term Proton Pump Inhibitor Use

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People who take proton pump inhibitors for acid reflux four-and-a-half years or more may have a higher risk of dementia compared to people who do not take these medications, according to new research published in Neurology.

Acid reflux is when stomach acid flows into the oesophagus, usually after a meal or when lying down, resulting in heartburn and ulcers. People with frequent acid reflux may develop gastroesophageal reflux disease, or GERD, which can lead to cancer of the oesophagus. Proton pump inhibitors reduce stomach acid by targeting the enzymes in the stomach lining that produce that acid.

“Proton pump inhibitors are a useful tool to help control acid reflux, however long-term use has been linked in previous studies to a higher risk of stroke, bone fractures and chronic kidney disease,” said study author Kamakshi Lakshminarayan, MBBS, PhD, of the University of Minnesota School of Public Health in Minneapolis, and a member of the American Academy of Neurology. “Still, some people take these drugs regularly, so we examined if they are linked to a higher risk of dementia. While we did not find a link with short-term use, we did find a higher risk of dementia associated with long-term use of these drugs.”

The study included 5712 people, aged 45 and up, without dementia at the start of the study. They had an average age of 75.

Researchers determined if participants took acid reflux drugs by reviewing their medications during study visits and during yearly phone calls. Of the participants, 1490 people, or 26%, had taken the drugs. Participants were then divided into four groups based on whether they had taken the drugs and for how long, as follows: people who did not take the drugs; those who took the drugs for up to 2.8 years; those who took them for 2.8 to 4.4 years; and people who took them for more than 4.4 years.

Participants were then followed for a median duration of 5.5 years. During this time, 585 people, or 10%, developed dementia.

Of the 4222 people who did not take the drugs, 415 people developed dementia, or 19 cases per 1000 person-years. Person-years represent both the number of people in the study and the amount of time each person spends in the study. Of the 497 people who took the drugs for more than 4.4 years, 58 people developed dementia, or 24 cases per 1000 person-years.

After adjusting for factors such as age, sex and race, as well as health-related factors such as high blood pressure and diabetes, researchers found people who had been taking acid reflux drugs for more than 4.4 years had a 33% higher risk of developing dementia than people who never took the drugs.

Researchers did not find a higher risk of dementia for people who took the drugs for fewer than 4.4 years.

“More research is needed to confirm our findings and explore reasons for the possible link between long-term proton pump inhibitor use and a higher risk of dementia,” said Lakshminarayan. “While there are various ways to treat acid reflux, such as taking antacids, maintaining a healthy weight, and avoiding late meals and certain foods, different approaches may not work for everyone. It is important that people taking these medications speak with their doctor before making any changes, to discuss the best treatment for them, and because stopping these drugs abruptly may result in worse symptoms.”

A limitation of the study was that participants were asked once a year about medication use, so researchers estimated use between annual check-ins. If participants stopped and restarted acid reflux drugs in between check-ins, estimation of their use may have been inaccurate. The authors were also unable to assess if participants took over the counter acid reflux drugs.

Source: American Academy of Neurology