Your Health by Dr. Rallie McAllister

If you're one of the millions of Americans suffering from heartburn or gastroesophageal reflux disease (GERD), you may be taking an acid-suppressing medication known as a proton pump inhibitor. While there's no doubt these drugs can be beneficial in the short run, recent research has uncovered a number of potential pitfalls associated with long-term use, including a higher risk of pneumonia, bone fractures and bacterial infections of the gastrointestinal tract.

Proton pump inhibitors, including Prilosec, Prevacid, Protonix and the like, work by blocking the production of hydrochloric acid in the stomach. As advertised, these medications are extremely effective, reducing acid secretion by as much as 99 percent.

Drastically reducing acid production for short periods of time can be therapeutic for many GERD sufferers. Low levels of acid in the stomach promote healing of ulcers and can ease the pain associated with heartburn and indigestion.

For most folks, however, continuous suppression of acid production for months or years isn't necessarily a good idea. In the stomach, hydrochloric acid plays a number of critical roles, including the destruction of Salmonella bacteria and other microorganisms responsible for food-borne illnesses.

Hydrochloric acid also helps prevent infection with Clostridium difficile, a type of bacterium responsible for ailments ranging from mild diarrhea to life-threatening inflammation of the colon. The results of a study published in the Journal of the American Medical Association demonstrated that use of proton pump inhibitors is associated with a significant increase in the risk of acquiring infection with Clostridium difficile bacteria.

In recent years, illnesses caused by Clostridium difficile increased in frequency in hospitals and communities. They've also become increasingly severe and more difficult to treat.

Individuals who use proton pump inhibitors appear to be at a greater risk of developing other types of infections, including those involving the respiratory tract. The results of a recent study showed that the use of acid-suppressing drugs was associated with a 27 percent increase in the risk of developing community-acquired pneumonia.

In addition to protecting us from disease-causing germs, hydrochloric acid in the stomach is also essential for the digestion of protein and for the proper absorption of nutrients, especially vitamin B12 and calcium.

Over time, insufficient absorption of calcium and vitamin B12 can lead to bone fragility in men and women.

Last year, Canadian researchers reported their findings that long-term use of proton pump inhibitors can dramatically increase the risk of bone fractures. The longer the drugs are used, the greater the risk of sustaining a fracture.

In a study of 135,000 people aged 50 or older, those taking the drugs at relatively high doses for more than a year were found to be 2.6 times more likely to break a hip compared to adults not taking the medications. In a study of nearly 16,000 patients, researchers found that individuals who had used proton pump inhibitors for at least seven years had almost double the risk of sustaining an osteoporosis-related bone fracture.

Long-term use of proton pump inhibitors has come under fire recently for another reason. Discontinuation of the drugs may produce an acid rebound phenomenon in which stomach acid secretion is even greater following treatment than it was before the therapy was initiated.

Earlier this month, the results of a study published in Gastroenterology, the official journal of the American Gastroenterological Association Institute, demonstrated that use of proton pump inhibitors could potentially lead to long-term dependency on the drugs. For the study, researchers gave healthy adult volunteers daily doses of proton pump inhibitors for eight weeks.

Although they had no history of GERD at the beginning of the study, 44 percent of the volunteers developed symptoms of heartburn or indigestion when they stopped taking the medication. In the four weeks following discontinuation of the drug, these individuals reported experiencing at least one significant acid-related symptom.

Based on their findings, the researchers speculated that proton pump dependency could help explain the rapidly and continuously increasing use of these drugs worldwide. Previous research revealed that nearly a third of patients who begin treatment with proton pump inhibitors continue taking the drugs without any obvious medical need for maintenance therapy.

If you've been taking proton pump inhibitors for months or years on end, it may be time to schedule an appointment with your physician to reassess your treatment plan. Together, you can decide whether the benefits of using acid-suppressing drugs outweigh the potential risks of long-term use.

Rallie McAllister is a board-certified family physician, speaker, and the author of several books, including "Fitness and Healthy Lunchbox: The Working Mom's Guide to Keeping You and Your Kids Trim." Her website is www.rallieonhealth.com. To find out more about Rallie McAllister, M.D., and read features by other Creators Syndicate writers and cartoonists, visit the Creators Syndicate Web page at www.creators.com.

COPYRIGHT 2009 CREATORS.COM