<<Disclaimer: Verify this information before applying it to your situation.>>
Two articles highlighting the risks associated with taking acid-suppressing
medications or antacids appeared in the news today. One study showed an
increased risk of community-acquired pneumonia in those taking acid
suppressors. Another study concerned the death of a liver transplant donor
whose death was found to be caused by the colonization of his stomach with
the bacteria, Clostridium perfringens, after consuming a lobster takeout
dinner following surgery. The patient had been given acid-suppressing H2
blockers before surgery. "Surgical stress, relative portal hypertension,
and subsequent acute gastropathy with an alkaline environment induced by
the H2 blocker most likely increased the stomach's susceptibility to
Clostridia," according to an Oct. 26, 2004 Reuters Health Information
article.
As multitudes of baby-boomers with an appetite for over-the-counter acid
suppressors enter the Medicare system, how many billions of taxpayer
dollars will go to treating illnesses caused by the unbridled and
unnecessary use of these acid-suppressing drugs being pushed on the public
by irresponsible, greedy pharmaceutical companies who deliberately hold
back known information about the harm long term use of these drugs can do?
This Celiac List has a number of postings in the archives about alternative
treatments for gastric acid related problems.
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Medscape Medical News
Acid-Suppressive Therapy May Increase Risk of Community-Acquired Pneumonia
CME
News Author: Laurie Barclay, MD
CME Author: Charles Vega, MD, FAAFP
Free Article (Free registration with Medscape may be required):
http://www.medscape.com/viewarticle/492096
"Oct. 26, 2004 -- Gastric acid-suppressive therapy increases the risk of
community-acquired pneumonia, according to the results of a case-control
analysis study published in the Oct. 27 issue of JAMA."
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JAMA. 2004;292:1955-1960.
Risk of Community-Acquired Pneumonia and Use of Gastric Acid-Suppressive
Drugs
Robert J. F. Laheij, PhD; Miriam C. J. M. Sturkenboom, PhD; Robert-Jan
Hassing, MSc; Jeanne Dieleman, PhD; Bruno H. C. Stricker, MD, PhD; Jan B.
M. J. Jansen, MD, PhD
Free Full Text HTML:
http://jama.ama-assn.org/cgi/content/full/292/16/1955
Free Full Text PDF:
http://jama.ama-assn.org/cgi/reprint/292/16/1955
ABSTRACT
Context: Reduction of gastric acid secretion by acid-suppressive therapy
allows pathogen colonization from the upper gastrointestinal tract. The
bacteria and viruses in the contaminated stomach have been identified as
species from the oral cavity.
Objective: To examine the association between the use of acid-suppressive
drugs and occurrence of community-acquired pneumonia.
Design, Setting, and Participants: Incident acid-suppressive drug users
with at least 1 year of valid database history were identified from the
Integrated Primary Care Information database between January 1, 1995, and
December 31, 2002. Incidence rates for pneumonia were calculated for
unexposed and exposed individuals. To reduce confounding by indication, a
case-control analysis was conducted nested in a cohort of incident users of
acid-suppressive drugs. Cases were all individuals with incident pneumonia
during or after stopping use of acid-suppressive drugs. Up to 10 controls
were matched to each case for practice, year of birth, sex, and index date.
Conditional logistic regression was used to compare the risk of community-
acquired pneumonia between use of proton pump inhibitors (PPIs) and H2-
receptor antagonists.
Main Outcome Measure: Community-acquired pneumonia defined as certain
(proven by radiography or sputum culture) or probable (clinical symptoms
consistent with pneumonia).
Results: The study population comprised 364 683 individuals who developed
5551 first occurrences of pneumonia during follow-up. The incidence rates
of pneumonia in non-acid-suppressive drug users and acid-suppressive drug
users were 0.6 and 2.45 per 100 person-years, respectively. The adjusted
relative risk for pneumonia among persons currently using PPIs compared
with those who stopped using PPIs was 1.89 (95% confidence interval, 1.36-
2.62). Current users of H2-receptor antagonists had a 1.63-fold increased
risk of pneumonia (95% confidence interval, 1.07-2.48) compared with those
who stopped use. For current PPI users, a significant positive dose-
response relationship was observed. For H2-receptor antagonist users, the
variation in dose was restricted.
Conclusion: Current use of gastric acid-suppressive therapy was associated
with an increased risk of community-acquired pneumonia.
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Fulminant Gas Gangrene Caused Death of Healthy Liver Donor
Reuters Health Information Oct 26, 2004
Free Article (Free registration with Medscape may be required):
http://www.medscape.com/viewarticle/492148
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Liver Transpl. 2004 Oct;10(10):1315-9
Fulminant and fatal gas gangrene of the stomach in a healthy live liver
donor.
Miller C, Florman S, Kim-Schluger L, Lento P, De La Garza J, Wu J, Xie B,
Zhang W, Bottone E, Zhang D, Schwartz M.
Recanati / Miller Transplantation Institute, New York, NY, USA.
[log in to unmask]
A 57-year-old male with a history of hypercholesterolemia and anxiety but
otherwise in good health volunteered to donate the right lobe of his liver
to his brother. The operation was performed uneventfully, without
transfusion. Postoperatively he did well, until he developed tachycardia,
profound hypotension, and coffee ground emesis on postoperative day 3.
Despite resuscitative measures, he arrested and expired. Autopsy
demonstrated gas gangrene of the stomach as the underlying cause of the
hemorrhage and numerous colonies of Gram-positive bacilli were identified.
Subsequent polymerase chain reaction (PCR) analysis identified these
bacteria to be Clostridium perfringens (C. perfringens) type D. This
patient's death was devastating, both to his family and his medical team.
The impact of his death has transcended that of an individual occurrence.
In conclusion, herein we present the facts and discuss this extraordinary
example of florid clostridial infection and toxin-mediated shock. It was
completely unexpected and probably unpreventable, and its cause was almost
inconceivable.
PMID: 15376309 [PubMed - in process]
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