Study Links Heartburn Drugs, Broken Hip

Taking such popular heartburn drugs as Nexium, Prevacid or Prilosec for a year or more can raise the risk of a broken hip markedly in people over 50, a large study in Britain found. (forbes.com 26.12.2006)

Overprescribing proton pump inhibitors - Editorials (BMJ 2008;336:2-3 (5 January))

Protonpumpehemmere øker ifølge FDA risiko for benbrudd (pharmatimes.com 26.5.2010)

Dobling av unge som bruker magesårmedisin (apotek.no 31.3.2008)

- Bruken av magesyrehemmere doblet på ti år. Norske leger skriver ut dobbelt så mange resepter på protonpumpehemmere som for ti år siden. Samtidig har nye studier koblet denne medisinen til demens og andre helseproblemer.

(Anm: Bruken av magesyrehemmere doblet på ti år. Norske leger skriver ut dobbelt så mange resepter på protonpumpehemmere som for ti år siden. Samtidig har nye studier koblet denne medisinen til demens og andre helseproblemer. Flere typer protonpumpehemmere ligger på lista over de 30 mest solgte legemidlene i Norge. (forskning.no 3.5.2017).)

(Anm: Proton Pump Inhibitors May Be Associated With Increased Risk of Dementia. CHICAGO -- February 16, 2016 -- The use of proton pump inhibitors (PPIs) may be associated with an increased risk of dementia, according to a study published online by JAMA Neurology. (…) Regular users of PPIs (n = 2,950) had a 44% increased risk of dementia compared with those not receiving PPI medication (n = 70,729). (dgnews.docguide.com 16.2.2016).)

- Vanlige magesyrehemmere (syrepumpehemmere) knyttet til høyere risiko for død. Bruk av protonpumpehemmere (PPI) - en klasse legemidler tatt av millioner for å behandle halsbrann og redusere magesyre - er knyttet til en høyere risiko for tidlig død. (- Resultatene legges til en voksende liste over alvorlige helseproblemer knyttet til bruk av PPI, hvorav noen inkluderer nyreskader, Clostridium difficile-infeksjoner, beinbrudd hos personer med osteoporose og demens.) (- Kan øke risikoen for vevskader som skyldes oksidativ stress og telomerer som forkortes i celler.)

(Anm: Vanlige magesyrehemmere (syrepumpehemmere) knyttet til høyere risiko for død. Common heartburn drugs tied to higher risk of death. Use of proton pump inhibitors - a class of drug taken by millions to treat heartburn and reduce stomach acid - is tied to a higher risk of premature death. So concludes a large study that followed nearly 350,000 United States veterans. Reporting their findings in the journal BMJ Open, researchers from Washington University School of Medicine in St. Louis explain how they also found that the risk of death rose with longer use of proton pump inhibitors (PPIs). "No matter how we sliced and diced the data from this large dataset, we saw the same thing: there's an increased risk of death among PPI users," says senior author Ziyad Al-Aly, an assistant professor of medicine. The findings add to a growing list of serious health problems tied to the use of PPIs, some of which include kidney damage, Clostridium difficile infection, bone fractures in people with osteoporosis, and dementia. Evidence is also emerging, although it is "far from conclusive," that PPIs may raise the risk of tissue damage resulting from oxidative stress and telomere shortening in cells. Telomeres are protective caps on the ends of chromosomes, which have been likened to the plastic ends on shoelaces that stop them unraveling. (…) The results showed that compared with use of H2 blockers, use of PPIs was tied to a 25 percent raised risk of death from all causes. (medicalnewstoday.com 4.7.2017).)

(Anm: Risk of death among users of Proton Pump Inhibitors: a longitudinal observational cohort study of United States veterans. Abstract Objective Proton pump inhibitors (PPIs) are widely used, and their use is associated with increased risk of adverse events. However, whether PPI use is associated with excess risk of death is unknown. We aimed to examine the association between PPI use and risk of all-cause mortality. Conclusions The results suggest excess risk of death among PPI users; risk is also increased among those without gastrointestinal conditions and with prolonged duration of use. Limiting PPI use and duration to instances where it is medically indicated may be warranted. BMJ Open 2017;7(6).)

(Anm: These Heartburn Drugs Are Linked to a Higher Risk of Early Death (time.com 5.7.2017).)

(Anm: Lederartikler. De forsømte psykologiske aspekter ved hudsykdom. (Editorials. The neglected psychological aspects of skin disease) Hudtilstander kan ha skadelige effekter på de fleste aspekter av en persons liv, inkludert relasjoner, arbeid, sosiale funksjoner, idrettsaktiviteter og til slutt psykisk helse. (Skin conditions can have a detrimental effect on most aspects of a person’s life, including relationships, work, social functioning, sporting activities, and ultimately their mental health. BMJ 2017;358:j3208 (Published 06 July 2017).)

- Bruk av syrenøytraliserende funnet å fremme leversykdom. (- Kjernepunktet i studien var overraskelsen at et bestemt type legemiddel, protonpumpehemmere (PPI), signifikant endret tarmbakterier.) (- Vi fant at fraværet av magesyre fremmer vekst av Enterococcus-bakterier i tarmene og translokasjon til leveren, der de forverrer betennelse og forverrer kronisk leversykdom.) (- Vår mage produserer magesyre for å drepe inntatte mikrober, og å ta legemidler for å undertrykke magesyreutskillelse kan endre sammensetningen av mikrobiomet i tarmen.)

(Anm: Use of antacids found to promote liver disease. A study emerging from the University of California, San Diego, has revealed a correlation between the use of common acid reflux medications and chronic liver disease. At the heart of the study was the revelation that a particular type of medicine, proton pump inhibitors (PPI), significantly altered gut bacteria. The research is particularly significant because of the amount of individuals who take acid reflux medicines, with as much as 10% of the population of the US taking PPIs. The number can increase seven-fold when individuals are experiencing chronic liver disease, potentially this may be caused, to a certain degree, by the use of the drugs. It was found that stomach acid suppression altered the gut bacteria in such a way as to increase likelihood of damage to the liver and to promote three types of chronic liver disease. "Our stomachs produce gastric acid to kill ingested microbes, and taking a medication to suppress gastric acid secretion can change the composition of the gut microbiome," said senior author Bernd Schnabl, Associate Professor of Gastroenterology at UC San Diego School of Medicine. "Since we found previously that the gut microbiome -- the communities of bacteria and other microbes living there -- can influence liver disease risk, we wondered what effect gastric acid suppression might have on the progression of chronic liver disease. We found that the absence of gastric acid promotes growth of Enterococcus bacteria in the intestines and translocation to the liver, where they exacerbate inflammation and worsen chronic liver disease." When found in increased levels, the Enterococcus bacterium was associated with mild steatosis and increased alcohol-induced liver disease in mouse models. In long-term studying of data, the researchers found that use of PPIs was associated with an increased 10-year risk of diagnosis of alcoholic liver disease of an 8.3% higher risk of liver disease against those who never used PPIs. (pharmafile.com 10.10.2017).)

- Langvarig bruk av PPI (protonpumpehemmere) linket til doblet risiko for magekreft, ifølge studie.

(Anm: Prolonged use of PPIs linked with two-fold increased risk of stomach cancer, study finds. A new study published in the online journal Gut suggested that the prolonged use of proton pump inhibitors (PPIs) that are mainly utilized in treating acid reflux is associated with more than a two-fold increase in the risk of gastric cancer. According to the study, after the elimination of Helicobacter pylori — bacteria associated with the cause of gastric cancer — the risk increases with the increase in the duration and dosage of the treatment. The risk of stomach cancer, which is the third leading cause of cancer death worldwide, can be lowered significantly by removing H pylori from the gut of the patients. However, there exists a chance of recurrence in a considerable number of patients even after successful treatment. (…) The researchers commented that PPIs are normally considered safe and as the study is observational, firm conclusions on cause and effect cannot be determined. However, the latest studies had associated the long-term use of PPIs to numerous ill-effects like heart attacks, pneumonia, and bone fractures. They are also thought to stimulate gastrin production, which is a strong growth-factor. Due to this strong dose and time response trend in the usage of PPIs and risk of gastric cancer, the researchers recommend doctors to be cautious when prescribing long-term PPIs even after eradicating H pylori successfully. (news-medical.net 1.11.2017).)

(Anm: Long-term proton pump inhibitors and risk of gastric cancer development after treatment for Helicobacter pylori: a population-based study. Abstract Objective Proton pump inhibitors (PPIs) is associated with worsening of gastric atrophy, particularly in Helicobacter pylori (HP)-infected subjects. We determined the association between PPIs use and gastric cancer (GC) among HP-infected subjects who had received HP therapy. Conclusion Long-term use of PPIs was still associated with an increased GC risk in subjects even after HP eradication therapy. Conclusion Long-term use of PPIs was still associated with an increased GC risk in subjects even after HP eradication therapy. Long-term proton pump inhibitors and risk of gastric cancer development after treatment for Helicobacter pylori: a population-based study. Gut 2017 (Published Online First: 31 October 2017).)

-  Langtidsbruk av PPIs var forbundet med en 2,4 ganger økt risko for magesekkreft blant pasienter som hadde hatt H.pylori-infeksjon og som hadde fått fjernet bakterien.

(Anm: Syrehemmende medisin øker risikoen for kreft i magesekken. Sterktvirkende syrehemmende midler, protonpumpehemmere, medfører forbigående atrofi av slimhinnen i magesekken, noe som øker risikoen for kreftutvikling ved langvarig behandling. (…) Langtidsbruk av PPIs var forbundet med en 2,4 ganger økt risko for magesekkreft blant pasienter som hadde hatt H.pylori-infeksjon og som hadde fått fjernet bakterien. Median observasjonstid var 7,6 år. (nhi.no 3.11.2017).)

- Er tarmmikrobiomet nøkkelen til helse og lykke? (- Forskning tyder på at det enorme økosystemet av organismer som lever i fordøyelsessystemene våre, kan være like så komplekse og innflytelsesrike som våre gener i alt fra mental helse til «atletisisme» (sportslige evner) og fedme.)

(Anm: Er tarmmikrobiomet nøkkelen til helse og lykke? Forskning tyder på at det enorme økosystemet av organismer som lever i fordøyelsessystemene våre, kan være like så komplekse og innflytelsesrike som våre gener i alt fra mental helse til «atletisisme» (sportslige evner) og fedme. Men er "poop doping" virkelig veien fremover? Is your gut microbiome the key to health and happiness? Research suggests the vast ecosystem of organisms that lives in our digestive systems might be as complex and influential as our genes in everything from mental health to athleticism sportslig evne and obesity. But is ‘poop doping’ really the way ahead? (theguardian.com 6.11.2017).)

- Hva som er årsaken til at forekomsten av kreft i tykk- eller endetarm øker så mye raskere her enn i andre land er foreløpig en gåte, men sannsynligvis har den generelle økningen med endringer i livsstil å gjøre.

(Anm: Tarmkreft: Forekomsten av tarmkreft i Norge har tredoblet seg. Det er mye stigma knyttet til kreftformen, og mange synes den er vanskelig å snakke om. Tarmkreft er en av de vanligste kreftformene i de fleste land i verden, og den har økt mye i den vestlige verden. I Norge er forekomsten nesten tredoblet siden 50-tallet. - Forekomsten i Norge er blant verdens høyeste, forteller Thomas de Lange ved Kreftregisteret. (…) - På 50-tallet lå vi bak både Sverige og Danmark, men nå er vi foran, og forekomsten her er nesten tredoblet, fortsetter han. Hva som er årsaken til at forekomsten av kreft i tykk- eller endetarm øker så mye raskere her enn i andre land er foreløpig en gåte, men sannsynligvis har den generelle økningen med endringer i livsstil å gjøre. - Det er mulig at det er arvelige faktorer som gjør at man kan være mer sårbar for de livsstilsendringene, sier de Lange, men påpeker at dette er rene hypoteser. LES OGSÅ: Øker risikoen for syv typer kreft (kk.no 17.11.2017).)

(Anm: Tarmkreft: Dette er tegnene på tarmkreft. - Det første som er viktig å tenke på hvis du mistenker tarmkreft er endringer i avføringsmønster, sier ekspert. Den vanligste og mest kjente formen for arvelig kreft er den typen tarmkreft en kan få hvis man har et høyt antall polypper. Ifølge Kreftforeningen er det trolig få tilfeller av tarmkreft der arv er eneste årsak, og levemåten vår kan påvirke risikoen for å utvikle krefttypen. (…) LES OGSÅ: Forekomsten av tarmkreft i Norge har tredoblet seg. (kk.no 17.11.2017).)

- Langtidsbruk av protonpumpehemmere øker risiko for benskjørhet.

Long term use of proton pump inhibitors raises risk of osteoporosis (Langtidsbruk av protonpumpehemmere øker risiko for benskjørhet)
BMJ 2008;337:a1272 (13 August 2008)
Patients who use proton pump inhibitors for seven or more years to treat reflux, peptic ulcers, and other conditions are at more risk of fractures related to osteoporosis, a large Canadian study has found (CMAJ 2008;179:319-26). (...)

- Studie linker syrehemmere til hoftebrudd.

Study Links Heartburn Drugs, Broken Hip
forbes.com 26.12.2006
Taking such popular heartburn drugs as Nexium, Prevacid or Prilosec for a year or more can raise the risk of a broken hip markedly in people over 50, a large study in Britain found.

The study raises questions about the safety of some of the most widely used and heavily promoted prescription drugs on the market, taken by millions of people.

The researchers speculated that when the drugs reduce acid in the stomach, they also make it more difficult for the body to absorb bone-building calcium. That can lead to weaker bones and fractures.

Hip fractures in the elderly often lead to life-threatening complications. As a result, doctors should make sure patients have good reason to stay on heartburn drugs long term, said study co-author Dr. Yu-Xiao Yang of the University of Pennsylvania School of Medicine.

"The general perception is they are relatively harmless," Yang said. "They often are used without a clear or justified indication for the treatment." (...)

- Mavesårsmedicin kan fremme leversygdom. Vær forsigtig med de såkaldte syrepumpehæmmere, advarer Peter Jepsen, speciallæge i leversygdomme og seniorforsker ved Aarhus Universitet.

(Anm: Mavesårsmedicin kan fremme leversygdom. Vær forsigtig med de såkaldte syrepumpehæmmere, advarer Peter Jepsen, speciallæge i leversygdomme og seniorforsker ved Aarhus Universitet. Et netop offentliggjort studie viser, at den ændrede syrebalance i mavesækken kan skabe en tarmflora, der fremmer leverskader. ”Læger bør være mere forsigtige med at udskrive mavesårsmedicin, der reducerer mængden af mavesyre - altså medicin med såkaldte syre- eller protonpumpehæmmere”. Sådan siger Peter Jepsen, speciallæge i leversygdomme og seniorforsker ved Klinisk Epidemiologisk Afdeling, efter at han har været med til at kortlægge nogle af syrepumpehæmmernes utilsigtede konsekvenser i en ny undersøgelse. Studiet, som er publiceret i Nature Communications, viser en utvetydig forbindelse mellem forbruget af syrepumpehæmmere og risikoen for senere at udvikle alvorlig leversygdom som fx skrumpelever. (…) Et studie af både dyr og mennesker I den danske del af studiet indgik alle de 4830 danskere, der havde fået registreret en sygehusdiagnose for skadeligt alkoholforbrug. Hele 21 procent af dem brugte syrepumpehæmmere, og disse personer havde større risiko for at udvikle skrumpelever end dem, der ikke brugte syrepumpehæmmere. (au.dk 10.10.2017).)

- Syrepumpehemmere (protonpumpehemmere (PPI) knyttet til alvorlige gastrointestinale infeksjoner.

(Anm: Syrepumpehemmere (protonpumpehemmere (PPI) knyttet til alvorlige gastrointestinale infeksjoner. (…) Legemidler som protonpumpehemmere (PPI) knyttet til en økt risiko for tarminfeksjoner med C. difficile og Campylobacter bakterier som kan forårsake betydelig sykdom. (Acid suppression medications linked to serious gastrointestinal infections. (…) Medications such as proton pump inhibitors (PPIs) was linked with an increased risk of intestinal infections with C. difficile and Campylobacter bacteria, which can cause considerable illness.) (medicalnewstoday.com 9.1.2017).)

(Anm: Overutilization of proton-pump inhibitors: what the clinician needs to know. Therap Adv Gastroenterol. 2012 Jul; 5(4): 219–232.)

- Påvirker langtidsbruk av protonpumpehemmere (syrepumpehemmere) (PPI) helsen til magens mikrobiota? (- Studiene som undersøkte virkningen av PPI på tarmmikrobiomet indikerer konsekvent at PPI-bruk påvirker endringen av tarmmikrobiomet. Derfor bør helsepersonell vurdere innflytelsen av PPI på tarmmikrobiom.)

(Anm: Does Long-Term Proton Pump Inhibitor Therapy Affect the Health of Gut Microbiota? Proton pump inhibitors (PPIs) are among the most widely sold medications in the world and are generally considered safe. PPIs are frequently prescribed or taken for long periods without evidence-based indication. However, long-term use of PPIs has not been studied in depth, and several side effects have recently been identified, including an increased risk of enteric infections such as small intestinal bacterial overgrowth and Clostridium difficile infections., The increased risk of enteric infections can be caused by the changes in the PPI-user’s gut microbiome, which result from the reduced acidity of the stomach and the subsequent survival of more bacteria that are ingested with food and oral mucus. Gut microbiota can resist or promote the colonization of C. difficile and other enteric infections through mechanisms that directly inhibit bacterial growth or enhance the immune system.  (…) To date, microbiota changes in terminal ileum due to PPI administration may be summarized as an increase in Firmicutes and/or a decrease in Bacteroidetes. Given the widespread use of PPI, adverse effects, including enteric infections, should not be overlooked. The studies investigating the impact of PPIs on the gut microbiome consistently indicate that PPI use affects the alteration of gut microbiome. Therefore, healthcare practitioners should consider the influence of PPI on gut microbiome. Gut Liver. 2016 Nov; 10(6): 865–866.)

(Anm: Antibiotika (tarmbakterier, probiotika, mikrobiota etc.) (Dysbiose; dysbiosis (also called dysbacteriosis (dysbakteriose)). (mintankesmie.no).)

- Vanlige legemidler mot reflux linket til progresjon av kronisk leversykdom.

(Anm: Vanlige legemidler mot reflux linket til progresjon av kronisk leversykdom. Common acid reflux drugs linked to progression of chronic liver disease. Approximately 10 percent of the general population take a proton pump inhibitor (PPI) drug to block stomach acid secretions and relieve symptoms of frequent heartburn, acid reflux and gastroesophageal reflux disease. That percentage can be as much as seven times higher for people with chronic liver disease. Researchers at University of California San Diego School of Medicine have discovered evidence in mice and humans that stomach (gastric) acid suppression alters specific gut bacteria in a way that promotes liver injury and progression of three types of chronic liver disease. The study is published October 10 in Nature Communications. (news-medical.net 10.10.2017).)

- Økonomiske interesser fra farmasøytisk industri har påvirket klinikere, forskere og kanskje også administratorer. Det store forbruket av protonpumpehemmere (PPI) hos særlig yngre er betenkelig – og må være basert på manglende biologisk forståelse fra alle nivåer i helsevesenet.

Betenkelig overforbruk blant unge
Kronikk: Helge L. Waldum, professor dr.med., Trondheim
dagensmedisin.no 20.6.2017
Økonomiske interesser fra farmasøytisk industri har påvirket klinikere, forskere og kanskje også administratorer. Det store forbruket av protonpumpehemmere (PPI) hos særlig yngre er betenkelig – og må være basert på manglende biologisk forståelse fra alle nivåer i helsevesenet. (…)

VÆR VARSOM! Det må også nevnes at de fleste kroniske inflammatoriske sykdommer (leddgikt, ulcerøs kolitt, Crohns sykdom), såkalte «autoimmune» sykdommer, kan skyldes infeksjoner. Det virker usannsynlig at så mange av våre sykdommer skulle skyldes feil i vårt eget forsvarssystem. (…)

- I sammenheng med svekket biologisk forståelse ser man en ensidig tro på kliniske studier, selv om disse varer bare noen måneder. Langtidsbivirkninger er det ikke fokusert på selv om så vel prion- som kreftsykdommer kan manifestere seg først etter flere dekader. Langtidsdyreforsøk er de eneste som kan gi indikasjon på slike bivirkninger, og rotta er genetisk mer enn 90 prosent lik mennesket.

- Innenfor administrasjon har jeg merket meg at for eksempel Statens Legemiddelverk ikke har tatt noen hensyn til mine høringsuttalelser, selv om det ikke er andre i Norge med eksperimentell kompetanse innen feltet.

Min konklusjon er at det store forbruket av PPI, særlig hos yngre individer, er meget betenkelig og må være basert på manglende biologisk forståelse i alle nivå av helsevesenet. (…)

(Anm: Habilitet (integritet) (mintankesmie.no).)

(Anm: Legemiddelindustrien (Big Pharma) (mintankesmie.no).)

(Anm: Statlig legemiddelkontroll (Statens legemiddelverk etc.) (mintankesmie.no).)

(Anm: Statlig hvitvasking av legemiddelinformasjon (Tidsskr Nor Legeforen 2010; 130:368 (25.2.2010).)

(Anm: Proton-Pump Inhibitors and Death — Association or Causation? David J. Bjorkman, MD, MSPH (HSA), SM (Epid.) reviewing Xie Y et al. BMJ Open 2017 Jul 4. Observational data show a weak association without evidence of causality. Comment Although this study featured an extensive statistical analysis, we must remember that statistics identify random variation but cannot correct for systemic biases and confounding. The authors estimate that the potential for residual confounding is small, but they acknowledge that confounding and biases could still explain the association. The limitations of the study include its observational nature, the highly selected population (veterans), the fact that PPI users were older and had more comorbidities, and failure to account for use of over-the-counter medications, such as nonsteroidal anti-inflammatory drugs. As with similar studies suggesting associations between PPI use and adverse events (NEJM JW Gastroenterol Aug 2017 and Gastroenterology 2017 May 18; [e-pub]) and the authors' prior study on chronic kidney disease (NEJM JW Gen Med Aug 2017 and Kidney Int 2017; 91:1482), these results suggest a weak association without evidence of causation and should not prevent patients from receiving PPI therapy for appropriate indications. NEJM 2017 (July 20, 2017).)

- Forskning bliver farlig, når de negative resultater glemmes.

(Anm: Forskning bliver farlig, når de negative resultater glemmes. (…) Nyt dansk studie viser problemet. (...) For få negative resultater leder til falske konklusioner. (…) Manglende negative resultater har kostet liv. (…) Vores model viser, at vi er nødt til at få publiceret mindst 20 procent af de negative resultater, der produceres inden for hvert forskningsfelt, hvis vi skal undgå at lave falske antagelser om videnskabelig fakta. (videnskab.dk 5.1.2017).)

- Færre tilbakefall enn antatt etter operasjon for refluks. (- Hos de som fikk tilbakefall, ble 83,6 prosent langtidsbehandlet med legemidler, mens 16,4 prosent ble operert på nytt. Blant alle i studien som ble operert, fikk 4 prosent komplikasjoner – de fleste mindre alvorlige.) (- Han legger til at tidligere studier som har sammenlignet medisinering og kirurgi har vist at livskvaliteten er bedre etter operasjon enn med bare legemiddelbehandling. – Operasjon har også vist å være mer kostnadseffektivt på lang sikt.)

(Anm: Færre tilbakefall enn antatt etter operasjon for refluks. – Trolig er kirurgi for lite brukt, særlig hos yngre og friske med store refluksplager, mener svensk forsker, som har sett på data fra alle refluks-opererte over en ni-årsperiode. For å kartlegge tilbakefall hos de som er operert for reflukssykdom, har forskere ved Karolinska Institutet fulgt alle voksne reflukspasienter som ble operert i Sverige i perioden 2005 til 2014.  Av disse 2655 hadde 17,7 prosent fått tilbakefall av refluks etter at de ble operert. Dette er ifølge pressemeldingen fra Karolinska Institutet, en lavere andel enn det som er vist i tidligere studier. Hos de som fikk tilbakefall, ble 83,6 prosent langtidsbehandlet med legemidler, mens 16,4 prosent ble operert på nytt. Blant alle i studien som ble operert, fikk 4 prosent komplikasjoner – de fleste mindre alvorlige. (…) – Denne typen operasjon med forholdsvis lav risiko for komplikasjoner kan være et for lite benyttet behandlingsalternativ, særlig hos unge og friske personer med alvorlig reflukssykdom, uttaler professor Jesper Lagergren, som er hovedansvarlig for studien. Han legger til at tidligere studier som har sammenlignet medisinering og kirurgi har vist at livskvaliteten er bedre etter operasjon enn med bare legemiddelbehandling. – Operasjon har også vist å være mer kostnadseffektivt på lang sikt, kommenterer Lagergren i pressemeldingen. (dagensmedisin.no 15.9.2017).)

(Anm: Association Between Laparoscopic Antireflux Surgery and Recurrence of Gastroesophageal Reflux. (…) Conclusions and Relevance Among patients who underwent primary laparoscopic antireflux surgery, 17.7% experienced recurrent gastroesophageal reflux requiring long-term medication use or secondary antireflux surgery. Risk factors for recurrence were older age, female sex, and comorbidity. Laparoscopic antireflux surgery was associated with a relatively high rate of recurrent gastroesophageal reflux disease requiring treatment, diminishing some of the benefits of the operation.JAMA. 2017;318(10):939-946.)

- Øker protonpumpehemmere risikoen for demens?

Do Proton Pump Inhibitors Increase the Risk of Dementia? (Øker protonpumpehemmere risikoen for demens?)
Editorial
JAMA Neurol. 2016 (Published online February 15, 2016)
Protonpumpeinhibitorer ble introdusert i 1980-årene for behandling av syrerelaterte lidelser i den øvre mage-tarmkanalen, bl.a. "halsbrann ", magesår, og gastrointestinal reflukssykdom.3 Legemidlene er tilgjengelige i USA både som reseptbelagte og reseptfrie legemidler. Flere studier har rapportert at 2 % til 3 % av befolkningen eldre enn 65 år fikk langsiktig PPI-terapi..4-6 Ifølge National Health and Nutrition Examination Survey økte bruken av protonpumpehemmere fra 3,4 % til 7,0 % blant menn og fra 4,8 % til 8,5 % blant kvinner fra1999-2000 til 2011-2013.7 (...) (Proton pump inhibitors were introduced in the 1980s for the treatment of acid-related disorders of the upper gastrointestinal tract, including “heartburn,” peptic ulcers, and gastrointestinal reflux disorders.3 The drugs are available in the United States, both as prescription and nonprescription drugs. Several studies have reported that 2% to 3% of the population older than 65 years of age were receiving long-term PPI therapy.4-6 In the National Health and Nutrition Examination Survey, use of PPIs increased from 3.4% to 7.0% among men and from 4.8% to 8.5% among women from 1999-2000 to 2011-2013.7)

Gomm et al2 har gitt en viktig og interessant utfordring mht. å vurdere en mulig sammenheng mellom bruk av protonpumpehemmere og risikoen for demens. (Gomm et al2 have provided an important and interesting challenge to evaluate the possible association of the use of PPIs and the risk of dementia.)

- Hva er en protonpumpehemmer?

(Anm: Hva er en protonpumpehemmer? Magen inneholder konsentrert saltsyre, som er nødvendig for fordøyelse av proteiner og absorpsjon av visse mineraler. Imidlertid, i henhold til sykdomstilstander, for eksempel magesår eller GERD (gastroøsofageal reflukssykdom), må produksjonen av denne syre til å bli betydelig redusert. For dette formålet, leger foreskrive en protonpumpehemmer (PPI), et medikament som blokkerer syreproduksjon i magen. To populære legemidler som tilhører denne gruppen er omeprazol og pantoprazol. (digidexo.com).)

- Protonpumpehemmere øker ikke risikoen for demens eller Alzheimers sykdom. (- Forskerne advarer om at det vil være behov for kliniske forsøk for å bekrefte om PPI er knyttet til økt risiko for kognitiv svikt.)

(Anm: Proton pump inhibitors do not increase risk for dementia or Alzheimer's disease. (…) They published their study in the Journal of the American Geriatrics Society. The researchers also examined whether people with mild cognitive impairment who took PPIs were at higher risk for developing dementia or Alzheimer's disease. (…) A higher percentage of people who took PPIs regularly or occasionally also took a higher percentage of anticholinergic medications, which are often used to treat incontinence, depression, and sleep disorders. These medications have been linked to cognitive impairment, too. (…)  The researchers cautioned that clinical trials would be needed to confirm whether PPIs were linked to a greater risk of cognitive decline. (news-medical.net 22.6.2017).)

(Anm: No Association Between Proton Pump Inhibitor Use and Risk of Alzheimer's Disease. Abstract OBJECTIVES: The objective of the study was to investigate whether proton pump inhibitor (PPI) use is associated with an increased risk of clinically verified Alzheimer's disease (AD). (…) CONCLUSIONS: In conclusion, we found no clinically meaningful association between PPI use and risk of AD. The results for longer duration of cumulative use or use with higher doses did not indicate dose-response relationship. Am J Gastroenterol advance online publication, 11 July 2017; doi:10.1038/ajg.2017.196. Am J Gastroenterol. 2017 Jul 11.)

(Anm: Habilitet (integritet) (mintankesmie.no).)

(Anm: Interessekonflikter, bestikkelser og korrupsjon (mintankesmie.no).)

(Anm: Bias [baies] -en, - skjevhet i vitenskapelig undersøkelse el. resultat pga. mangelfull systematikk i innsamlingen av data. Etym.: eng., fr. biais helning, tendens. Kilde: ordnett.no.)

(Anm: Bias; (...) valg og vurderinger som på systematisk måte avviker fra det som er faktisk korrekt. Kilde: Store norske leksikon.)

(Anm: Legemiddeletterlevelse (Tas legemidler som foreskrevet?) (Adherence to Medication.) (…) Legemidler virker ikke på pasienter som ikke tar dem. (Drugs don't work in patients who don't take them.)  (NEJM 2005;353:487-497(August 4).)

- Konklusjoner. I en analyse av data fra Nurses 'Health Study II, observerte vi ikke en overbevisende forbindelse mellom PPI-bruk og kognitiv funksjon.

(Anm: Association Between Proton Pump Inhibitor Use and Cognitive Function in Women. Abstract Background & Aims Studies have reported associations between proton pump inhibitor (PPI) use and dementia. However, data are lacking on long-term PPI use and cognitive function. We therefore examined associations between PPI use and performance in tests of cognitive function. Because of shared clinical indications, we examined associations for H2 receptor antagonists (H2RAs) as a secondary aim. (…) Results We observed a modest association between duration of PPI use and scores for psychomotor speed and attention (mean score difference for PPI use of 9–14 yrs vs never users, –0.06; 95% CI, –0.11 to 0.00; Ptrend = .03). After controlling for H2RA use, the magnitude of this score difference was attenuated. Among individuals who did not regularly use PPIs, duration of H2RA use was associated with poorer cognitive scores, with the strongest association apparent for learning and working memory (mean score difference for H2RA users of 9–14 years vs never users, –0.20; 95% CI, –0.32 to –0.08; Ptrend < .001). Conclusions In an analysis of data from the Nurses’ Health Study II, we did not observe a convincing association between PPI use and cognitive function. Our data do not support the suggestion that PPI use increases dementia risk. Since our primary hypothesis related to PPI use, our findings for H2RAs should be interpreted with caution. Gastroenterology 2017 (published online 18 July 2017).)

(Anm: Setting the record straight: Proton-pump inhibitors (PPIs) do not cause dementia. Several studies have reported associations between proton-pump inhibitor (PPI) use and dementia. New research published in Gastroenterology, the official journal of the American Gastroenterological Association (AGA), puts these claims to rest. The study authors report that there is no convincing evidence to support the suggestion that PPI use increases dementia risk. (medicalnewstoday.com 24.7.2017).)

- Forekomst og markører for ikke-bevisbaser bruk av protonpumpehemmere / syrehjemmere (PPI-er) blant eldre sykehjem bosatt i USA. (- KONKLUSJONER Den nåværende studien viste at nesten halvparten av de eldre sykehjemsbeboere brukte PPI-er (protonpumpehemmere / syrehemmere) på ikke-bevisbaserte indikasjoner. Gitt sikkerhetsproblemene og høy ikke-bevisbaser bruk av PPI i sykehjem, er det et presserende behov for å optimalisere PPI-bruk hos eldre.)

Prevalence and predictors of non-evidence based proton pump inhibitor use among elderly nursing home residents in the US. (Forekomst og markører for ikke-bevisbaser bruk av protonpumpehemmere / syrehjemmere (PPI-ere) blant eldre sykehjem bosatt i USA.)
Res Social Adm Pharm. 2017 Mar - Apr;13(2):358-363. doi: 10.1016/j.sapharm.2016.02.012. Epub 2016 Mar 8.
Abstract
BAKGRUNN Formålet med denne studien var å undersøke prevalensen og prediktorene av ikke-bevisbasert PPI-bruk hos eldre på sykehjem. (BACKGROUND: Proton pump inhibitors (PPIs) can lead to several adverse effects among the elderly, particularly when used inappropriately or in contrast to evidence suggested protocols.)

OBJECTIVE: The aim of this study was to examine the prevalence and predictors of non-evidence based PPI use in elderly nursing home residents.

METHODS: A cross-sectional study was conducted using data from the 2004 National Nursing Home Survey (NNHS). The study sample included nursing home residents 65 years and older. Descriptive statistics were used to examine the prevalence of non-evidence based PPI use. Multivariable logistic regression was used to evaluate the patient and facility-level factors associated with non-evidence based PPI use among the elderly nursing home residents.

RESULTS: A total of 355,600 elderly nursing home residents received at least one PPI for an overall prevalence of 26.99%. Among those elderly receiving PPIs, 48.59% of the use was not evidence based. Multivariable logistic regression revealed that residents with osteoporosis (Odds Ratio (OR): 0.55, 95% CI: 0.45-0.68), SSRI users (OR: 0.81, 95% CI: 0.68-0.97) and those residing in micropolitan area (OR: 0.79, 95% CI: 0.63-0.98) were negatively associated with prescription of PPIs without an indication. Patients with chronic cough (OR: 2.10, 95% CI: 1.12-3.96) and Medicare insurance (OR: 1.23, 95% CI: 1.01-1.50) were positively associated with prescription of PPIs without an indication.

KONKLUSJONER Den nåværende studien viste at nesten halvparten av de eldre sykehjemsbeboere brukte PPI-er for ikke-bevisbaserte indikasjoner. Gitt sikkerhetsproblemene og høy ikke-bevisbaser bruk av PPI i sykehjem, er det et presserende behov for å optimalisere PPI bruk hos eldre. (…) (CONCLUSIONS: The current study found that almost half of the elderly nursing home residents used PPIs for non-evidence based indications. Given the safety concerns and high non-evidence based use of PPIs in nursing homes, there is an urgent need to optimize PPI use in the elderly.)

(Anm: Editorial | Do Proton Pump Inhibitors Increase the Risk of Dementia? JAMA Neurol. 2016 (Published online February 15, 2016).)

(Anm: Proton pump inhibitors may be associated with increased risk of dementia. The use of proton pump inhibitors, the popular medications used to treat gastroesophageal reflux and peptic ulcers, may be associated with an increased risk of dementia in a study using data from a large German health insurer, according to an article published online by JAMA Neurology. (medicalnewstoday.com 15.2.2016).)

(Anm: Association of Proton Pump Inhibitors With Risk of Dementia. A Pharmacoepidemiological Claims Data Analysis. JAMA Neurol. 2016 (Published online February 15, 2016).)

(Anm: Association Between Proton-Pump Inhibitors and Dementia? An observational study that suggested this association has considerable limitations. NEJM 2016 (May 19, 2016).)

- Hemming av magesyre og risiko for periodisk Clostridium difficile-infeksjon. (- Risiko var spesielt forhøyet i studier som involverte protonpumpehemmere.)

Gastric Acid Suppression and Risk for Recurrent Clostridium difficile Infection
NEJM 2017 (April 13, 2017).)
Thomas L. Schwenk, MD reviewing Tariq R et al. JAMA Intern Med 2017 Mar 27.
Risiko var spesielt forhøyet i studier som involverte protonpumpehemmere. (Risk was particularly elevated in studies that involved proton-pump inhibitors.)

Evidence of a relation between proton-pump inhibitors (PPIs) and risk for an initial episode of Clostridium difficile infection (CDI) is somewhat mixed but sufficient for the FDA to issue a warning. In this meta-analysis of 16 observational studies, researchers examined whether risk for recurrent CDI was higher in patients who took gastric acid suppressants (PPIs, histamine-2–receptor antagonists [H2RAs], or both) between initial and recurrent CDI episodes. Recurrent CDI was defined variably across studies as occurring within 30, 60, or 90 days after resolution of initial infection.

En bemerkelsesverdig 52 % av 7 700 pasienter med innledende CDI tok syreundertrykkende midler. Risikoen for gjentatt CDI var betydelig høyere blant de som brukte syreundertrykkende legemidler enn blant de som ikke gjorde det (2 2% versus 17 %, justert oddsforhold, 1,52). I undergruppeanalyser var sammenhengen mellom syrehemmende midler og gjentatt CDI signifikant i studier hvor bare PPI ble brukt (OR, 1,66), men ikke hos de som involverte både PPI og H2RA (OR, 1,37). (A remarkable 52% of 7700 patients with initial CDI were taking acid suppressants. Risk for recurrent CDI was significantly higher among those who used acid suppressants than among those who did not (22% vs. 17%; adjusted odds ratio, 1.52). In subgroup analyses, the association between acid suppressants and recurrent CDI was significant in studies in which only PPIs were used (OR, 1.66) but not in those that involved both PPIs and H2RAs (OR, 1.37).)

- Mavesårsmedicin øger risikoen for apopleksi (hjerneslag). Nyt dansk studie viser, at syreneutraliserende midler af typen PPI øger risikoen for blødning eller blodprop i hjernen.

(Anm: Mavesårsmedicin øger risikoen for apopleksi (hjerneslag). Nyt dansk studie viser, at syreneutraliserende midler af typen PPI øger risikoen for  blødning eller blodprop i hjernen. Det er det første studie, der sætter fokus på PPI og risiko for apopleksi på verdensplan. (dagenspharma.dk 16.11.2016).)

(Anm: apopleksi, apoplexia cerebri, hjerneslag, akutte fokale nevrologiske symptomer og utfall som varer i mer enn 24 timer og som skyldes skade av hjernevev enten på grunn av regionalt redusert blodsirkulasjon (hjerneinfarkt) eller på grunn av hjerneblødning. Kilde: Store norske leksikon.)

(Anm: Cardiovascular outcomes with clarithromycin. Study provides insufficient evidence of a link between clarithromycin and myocardial infarction. (…) The treatment they chose to analyse also contains a proton pump inhibitor. Given that these drugs may inhibit common antiplatelet agents,4 5 and a similar study suggests they independently increase the risk of myocardial infarction by a similar magnitude,6 is it fair to blame clarithromycin? BMJ 2016;352:i1342 (Published 08 March 2016).)

- PPI kan øge risiko for hjerneblodprop.

(Anm: PPI kan øge risiko for hjerneblodprop Foreløbige resultater fra en dansk kohorteundersøgelse stiller spørgsmålstegn ved den kardiovaskulære sikkerhed ved protonpumpehæmmere (PPI’er). Det skriver Dagens Pharma onsdag med henvisning til data, netop er præsenteret på American Heart Association kongres i New Orleans. Resultaterne viser, at overordnet var risikoen for en blodprop i hjernen øget med 19 pct. hos de patienter, som også fik en PPI. Risikoen afhænger dog af dosis, hvor de lavere doser ikke ser ud til at forøge rsikoen, mens der for de høje doser kan være en øget risiko på mellem 33 og 79 pct., afhængig af PPI-typen. (pharmadanmark.dk 25.11.2016).)

- Langvarig brug af syrepumpehæmmere kædes sammen med uopdaget nyreskade.

(Anm: Langvarig brug af syrepumpehæmmere kædes sammen med uopdaget nyreskade (dagenspharma.dk 1.3.2017).)

- Kombinasjon av NSAID og magebeskyttelse kan føre til betennelse i tynntarm.

(Anm: Patients with inflammatory diseases are often prescribed non-steroidal anti-inflammatory drugs. They are also often recommended to use a proton pump inhibitor to protect their stomach. In a joint study, clinical pharmacologist Markus Zeitlinger and gastroenterologist Werner Dolak from MedUni Vienna showed that this combination of medication can result in inflammation in the small intestine. However, if an antibiotic (rifaximin) is additionally given, the intestine remains protected. The study has now been published in the leading journal "Gastroenterology". (news-medical.net 11 .4.2017).)

(Anm: Antibiotika associeras med högre risk för tarmcancer. (…) Det här är första studien som visar på sambandet mellan antibiotikaanvändning och utveckling av adenom i tjock- och ändtarmen. Studien publiceras i den vetenskapliga tidskriften Gut. (…) Resultatet visade att långvarig antibiotikaanvändning tidigare i livet, i åldern 20 till 59 år, hade samband med diagnostiserade adenom. (lakemedelsvarlden.se 5.4.2017.)

(Anm: Antibiotika (tarmbakterier, probiotika, mikrobiota etc.) (Dysbiose; dysbiosis (also called dysbacteriosis (dysbakteriose)). (mintankesmie.no).)

- Protonpumpehemmere og magekreft. Langtidsbivirkninger av medisiner kan overses i randomiserte, kontrollerte legemiddelutprøvninger fordi oppfølgingstiden er for kort. Vi har lenge visst at protonpumpehemmere gir magekreft hos gnagere, og det er ingen åpenbar biologisk grunn til at dette skulle være annerledes hos menneske.

(Anm: Protonpumpehemmere og magekreft. Langtidsbivirkninger av medisiner kan overses i randomiserte, kontrollerte legemiddelutprøvninger fordi oppfølgingstiden er for kort. Vi har lenge visst at protonpumpehemmere gir magekreft hos gnagere, og det er ingen åpenbar biologisk grunn til at dette skulle være annerledes hos menneske. Tidsskr Nor Legeforen 2016; 136:13 (12.1.2016).)

- Populære legemidler mot halsbrann og sure oppstøt knyttet til gradvis utvikling av «tause» nyreskader. (- Over fem år med oppfølging fant forskerne at mer enn 80 prosent av PPI brukere ikke utviklet akutte nyreproblemer, som ofte er reversibel og er preget av at for lite urin forlater kroppen, tretthet (fatigue) og hevelse i bena og anklene.)

Popular heartburn drugs linked to gradual yet 'silent' kidney damage
medicalnewstoday.com 23.2.2017
Å ta populære halsbrannlegemidler over lengre tid har vært knyttet til alvorlige nyreproblemer, blant annet nyresvikt. De plutselige oppståtte nyreproblemer fungerer ofte som signal for leger om å stanse sine pasienters bruk av såkalte protonpumpehemmere (PPI), som selges under merkenavnene Prevacid, Prilosec, Nexium og Protonix, blant andre. (Taking popular heartburn drugs for prolonged periods has been linked to serious kidney problems, including kidney failure. The sudden onset of kidney problems often serves as a red flag for doctors to discontinue their patients' use of so-called proton pump inhibitors (PPIs), which are sold under the brand names Prevacid, Prilosec, Nexium and Protonix, among others.)

But a new study evaluating the use of PPIs in 125,000 patients indicates that more than half of patients who develop chronic kidney damage while taking the drugs don't experience acute kidney problems beforehand, meaning patients may not be aware of a decline in kidney function, according to researchers at Washington University School of Medicine in St. Louis and the Veterans Affairs St. Louis Health Care System. Therefore, people who take PPIs, and their doctors, should be more vigilant in monitoring use of these medications.

The study is published in Kidney International.

The onset of acute kidney problems is not a reliable warning sign for clinicians to detect a decline in kidney function among patients taking proton pump inhibitors, said Ziyad Al-Aly, MD, the study's senior author and an assistant professor of medicine at Washington University School of Medicine. "Our results indicate kidney problems can develop silently and gradually over time, eroding kidney function and leading to long-term kidney damage or even renal failure. Patients should be cautioned to tell their doctors if they're taking PPIs and only use the drugs when necessary."

More than 15 million Americans suffering from heartburn, ulcers and acid reflux have prescriptions for PPIs, which bring relief by reducing gastric acid. Many millions more purchase the drugs over-the-counter and take them without being under a doctor's care.

The researchers - including first author Yan Xie, a biostatistician at the St. Louis VA - analyzed data from the Department of Veterans Affairs databases on 125,596 new users of PPIs and 18,436 new users of other heartburn drugs referred to as H2 blockers. The latter are much less likely to cause kidney problems but often aren't as effective.

Over fem år med oppfølging fant forskerne at mer enn 80 prosent av PPI brukere ikke utviklet akutte nyreproblemer, som ofte er reversibel og er preget av at for lite urin forlater kroppen, tretthet (fatigue) og hevelse i bena og anklene. (Over five years of follow up, the researchers found that more than 80 percent of PPI users did not develop acute kidney problems, which often are reversible and are characterized by too little urine leaving the body, fatigue and swelling in the legs and ankles.)

However, more than half of the cases of chronic kidney damage and end-stage renal disease associated with PPI use occurred in people without acute kidney problems.

In contrast, among new users of H2 blockers, 7.67 percent developed chronic kidney disease in the absence of acute kidney problems, and 1.27 percent developed end-stage renal disease.

End-stage renal disease occurs when the kidneys can no longer effectively remove waste from the body. In such cases, dialysis or a kidney transplant is needed to keep patients alive.

"Doctors must pay careful attention to kidney function in their patients who use PPIs, even when there are no signs of problems," cautioned Al-Aly, who also is the VA's associate chief of staff for research and education and co-director of the VA's Clinical Epidemiology Center. "In general, we always advise clinicians to evaluate whether PPI use is medically necessary in the first place because the drugs carry significant risks, including a deterioration of kidney function."

(Anm: Long-term kidney outcomes among users of proton pump inhibitors without intervening acute kidney injury. Kidney International 2017 (published online 22 February 2017.)

(Anm: Do Proton-Pump Inhibitors Cause Chronic Kidney Disease? Allan S. Brett, MD reviewing Xie Y et al. Kidney Int 2017 Jun. Another observational study suggests an association, but a causal relation has not been proven. Do Proton-Pump Inhibitors Cause Chronic Kidney Disease? Allan S. Brett, MD reviewing Xie Y et al. Kidney Int 2017 Jun. Another observational study suggests an association, but a causal relation has not been proven. (…) During 5 years of follow-up, PPI use was associated with significantly higher risk for developing CKD, regardless of whether CKD was defined as a fall in GFR to <60 mL/minute/1.73 m2 or as reduction in GFR by 30% or 50%; hazard ratios ranged from 1.2 to 1.3. At 5 years, PPI use was associated with roughly 4% excess absolute risk for GFR <60 mL/minute/1.73 m2 and roughly 0.5% excess absolute risk for >50% reduction in GFR. Duration of PPI exposure correlated with extent of excess risk for CKD. (NEJM 2017 (July 6, 2017).)

- Halsbrann-pille kan gjøre blodårene gamle. (- Over 400 000 nordmenn fikk skrevet ut protonpumpehemmere i 2014. Nå knyttes pillene til økt risiko for hjerteinfarkt, nyresvikt og demens.)

Halsbrann-pille kan gjøre blodårene gamle
forskning.no 16.5.2016
Hundretusenvis av nordmenn bruker medisiner som nå kobles til hjerteinfarkt, nyresvikt og demens.
Over 400 000 nordmenn fikk skrevet ut protonpumpehemmere i 2014. Nå knyttes pillene til økt risiko for hjerteinfarkt, nyresvikt og demens

Over én av ti nordmenn lider av den lite omtalte folkesykdommen GERD – gastroøsofageal reflukssykdom – som kan gi mye ubehag og redusert livskvalitet.

Mange av disse menneskene bruker såkalte protonpumpehemmere, medisiner som effektivt reduserer syrenivået i magen. Tall fra 2014 viser at over 400 000 nordmenn fikk utskrevet slike legemidler.

Pillene er tilsynelatende så trygge og effektive at nesten ingen fagfolk lenger gidder å forske på de underliggende årsakene til GERD.

Les mer: Mirakelpillen som parkerte halsbrann-forskningen

Men i det siste har det dukket opp undersøkelser som antyder at protonpumpehemmere ikke er så ufarlige som vi har trodd. Tvert mot har studiene koblet langvarig bruk av slike legemidler til økt risiko for hjerteinfarkt, nyresvikt og demens.

Les mer fra Nasjonal kompetansetjeneste for aldring og helse: Kan magesårmedisin gi demens?

Og nå kommer en undersøkelse som kanskje viser hvorfor.

Raskere aldring
Gautham Yepuri fra Houston Methodist Research Institute og kollegaene hans har forsket på celler fra menneskelige blodårer. De utsatte cellene for nivåer av medikamentet som tilsvarer en tablett på 40 milligram eller det dobbelte.

Resultatene viste at legemidlet fikk cellene til å eldes raskere. Dette kan forklare hvorfor protonpumpehemmerne har vært koblet til både hjerteinfarkt, nyresvikt og demens, skriver forskerne i tidsskriftet Circulation Research.

Forskerne presiserer imidlertid at aldringseffekten bare dukket opp når cellene ble eksponert for medikamentet over lengre tid. I tillegg så de ingen slik effekt når cellene ble utsatt for H2-blokkere, et annet magesyrehemmende middel. (…)

(Anm: Proton Pump Inhibitors Accelerate Endothelial Senescence. CONCLUSIONS: Our data may provide a unifying mechanism for the association of PPI use with increased risk of cardiovascular, renal, and neurological morbidity and mortality. Circ Res. 2016 Jun 10;118(12):e36-42. Epub 2016 May 10.)

(Anm: Langvarig bruk av legemidler til behandling av halsbrann, magesår og sure oppstøt kan føre til alvorlige nyreskader, inkludert nyresvikt, ifølge en studie utført av forskere ved Washington University School of Medicine i St. Louis og Veterans Affairs St. Louis Health Care System. (Extended use of drugs to treat heartburn, ulcers and acid reflux may lead to serious kidney damage, including kidney failure, according to a study by researchers at Washington University School of Medicine in St. Louis and Veterans Affairs St. Louis Health Care System. (medicalnewstoday.com 6.5.2016).)

(Anm: Surprising Things That Hurt Your Heart (wbmed 17.9.2015).)

(Anm: Heart Disease: Causes of a Heart Attack (medicinenet.com 6.8.2016).)

(Anm: Symptoms of Heart Disease and Heart Attack (medicinenet.com 27.7.2016).)

(Anm: 12 Clues You Might Have Heart Disease (webmd.com 7.6.2016).)

(Anm: Surprising Causes of Chest Pain (webmd.com 1.12.2016).)

(Anm: Baking Soda for Acid Reflux: Does it Work? (webmd.com 1.1.2016).)

(Anm: Sore Throat and Acid Reflux: Causes and Treatment. (medicalnewstoday.com 8.1.2017).)

(Anm: Acid Reflux in Infants: Causes, Symptoms, and Treatment (webmd.com 3.2.2017).)

(Anm: Slideshow: Surprising Reasons You're in Pain (webmd.com 5.12.2016).)

(Anm: High Bilirubin Levels: Symptoms and Tests (medicalnewstoday.com 9.1.2017).)

(Anm: Syrepumpehemmere (protonpumpehemmere (PPI) knyttet til alvorlige gastrointestinale infeksjoner. (…) Legemidler som protonpumpehemmere (PPI) knyttet til en økt risiko for tarminfeksjoner med C. difficile og Campylobacter bakterier som kan forårsake betydelig sykdom. (Acid suppression medications linked to serious gastrointestinal infections. (…) Medications such as proton pump inhibitors (PPIs) was linked with an increased risk of intestinal infections with C. difficile and Campylobacter bacteria, which can cause considerable illness.) (medicalnewstoday.com 9.1.2017).)

- Magnesiummangel og protonpumpehemmere

Magnesiummangel og protonpumpehemmere
Tidsskr Nor Legeforen - Publisert først på nett 22. august 2016
En rekke sykdomstilstander kan gi magnesiummangel. Den kliniske presentasjonen kan være svært ulik og avhenger av tidsforløpet så vel som eksakt serumverdi av magnesium. Magnesiummangel kan også være en bivirkning av medikamentgruppen protonpumpehemmere. Man bør ha lav terskel for å undersøke elektrolyttstatus i oppfølging og utredning av pasienter som bruker slike medikamenter.

I Tidsskriftet nr. 13 – 14/2016 ble det i spalten Noe å lære av beskrevet en kvinne i 70-årene med rask forverring av kognitiv funksjon (1). Etter en omfattende geriatrisk utredning konkluderer forfatterne med at en langsom progredierende total magnesiummangel, som følge av mangelfull ernæring over tid og bruk av protonpumpehemmer, var årsak til pasientens symptomer. Videre poengterer de at det ved kognitiv svikt er viktig med rask og bred utredning, inkludert elektrolyttstatus og grundig gjennomgang av medisinlisten, da dette kan avdekke bakenforliggende årsaker som effektivt kan behandles. Etter korrigering av elektrolytter og seponering av protonpumpehemmer viste den eldre kvinnen klinisk bedring og tilnærmet normalisering av kognitiv funksjon.

Vi har nylig publisert en kasuistikk der vi også presenterer en pasient med magnesiummangel (2). Både det kliniske bildet og forløpet er svært forskjellig fra kasuistikken i Tidsskriftet. (…)

- EUs sikkerhedssignaler (...) Protonpumpehæmmere – gastriske polypper

EU’s liste med anbefalinger i forbindelse med sikkerhedssignaler
Nyt Om Bivirkninger 2017(1) JANUAR 2017
I forbindelse med den rutinemæssige lægemiddelovervågning i EU vurderer EU’s bivirkningskomité (PRAC) hver måned signaler om mulige bivirkninger for at afgøre, om der er behov for iværksættelse af yderligere tiltag for at øge sikkerheden ved medicinen.

Listen over de signaler, hvor PRAC har vurderet, at der skal foretages yderligere tiltag, bliver offentliggjort på Det Europæiske Lægemiddelagenturs hjemmeside hver måned.

De væsentligste signaler, der blev drøftet ved mødet i PRAC d. 28. november - 1. december 2016, drejer sig om:

  • Phenprocoumon – kalcifylakse
  • Methylphenidat – priapisme
  • Protonpumpehæmmere – gastriske polypper
  • Vildagliptin; Vildagliptin+metformin – pemfigoid.

Se EU’s liste med anbefalinger i forbindelse med sikkerhedssignaler: PRAC recommendations on signals adopted 28 November-1 December 2016 samt de danske oversættelser til produktinformationen. (…)

(Anm: Polypper i mage-tarm? (…) Undersøkelser som kan avsløre om man har polypper er gastroskopi og koloskopi, altså kikkertundersøkelser henholdsvis ovenfra og nedenfra. Dette er de beste undersøkelsene. Det går også an å gjøre en røntgenundersøkelse med kontrast i tykktarmen. Polypper gir vanligvis ikke smerter i det hele tatt. Noen pasienter kan ha blod i avføringen. Det er ugunstig å ha polypper i lang tid. Noen polypper kan bli ondartede. Symptomene dine gir ikke først og fremst mistanke om polypper. Fastlegen din bør kunne henvise deg vurdering hos spesialist i mage-tarm-sykdommer. Lykke til! (lommelegen.no 26.3.2007).)

- Protonpumpehæmmere: dexlansoprazol; esomeprazol; lansoprazol; omeprazol; pantoprazol; rabeprazol – gastriske polypper (EPITT-nr. 18725).)

3.  Protonpumpehæmmere: dexlansoprazol; esomeprazol; lansoprazol; omeprazol; pantoprazol; rabeprazol – gastriske polypper (EPITT-nr. 18725)
ema.europa.eu (15 December 2016 EMA/PRAC/849492/2016 Pharmacovigilance Risk Assessment Committee (PRAC))
Produktresumé (både receptpligtig og receptfri medicin)
4.8. Bivirkninger
Mave-tarm-kanalen: Benigne gastriske polypper
Hyppighed: "almindelig"

Indlægsseddel (både receptpligtig og receptfri medicin)

4 – Bivirkninger
Godartede polypper i mavesækken
Hyppighed: "almindelig" (…)

(Anm: Polypper i mage-tarm? (…) Hei! Undersøkelser som kan avsløre om man har polypper er gastroskopi og koloskopi, altså kikkertundersøkelser henholdsvis ovenfra og nedenfra. Dette er de beste undersøkelsene. Det går også an å gjøre en røntgenundersøkelse med kontrast i tykktarmen. Polypper gir vanligvis ikke smerter i det hele tatt. Noen pasienter kan ha blod i avføringen. Det er ugunstig å ha polypper i lang tid. Noen polypper kan bli ondartede. Symptomene dine gir ikke først og fremst mistanke om polypper. Fastlegen din bør kunne henvise deg vurdering hos spesialist i mage-tarm-sykdommer. Lykke til! (lommelegen.no 26.3.2007).)

- Protonpumpehemmere linket til alvorlig risiko for nyresykdom. (- Forskning viser protonpumpehemmere bør brukes med måte.)

Research indicates proton pump inhibitors should be used only sparingly.
medicalnewstoday.com 6.5.2016
Langvarig bruk av legemidler til behandling av halsbrann, magesår og sure oppstøt kan føre til alvorlige nyreskader, inkludert nyresvikt, ifølge en studie utført av forskere ved Washington University School of Medicine i St. Louis og Veterans Affairs St. Louis Health Care System. (Extended use of drugs to treat heartburn, ulcers and acid reflux may lead to serious kidney damage, including kidney failure, according to a study by researchers at Washington University School of Medicine in St. Louis and Veterans Affairs St. Louis Health Care System.)

More than 15 million Americans have prescriptions for so-called proton pump inhibitors (PPIs), which decrease gastric acid production and generally have been considered safe.

Furthermore, researchers found the risk of kidney problems rises the longer patients take the medications, sold under the brand names Prevacid, Prilosec, Nexium and Protonix, among others.

The epidemiological study is available online in the Journal of the American Society of Nephrology.

"We advise patients to limit the use of PPIs only to when they are medically necessary and for the shortest duration possible," said Ziyad Al-Aly, MD, an assistant professor of medicine at Washington University and the study's senior author. (…)

(Anm: Langvarig brug af syrepumpehæmmere kædes sammen med uopdaget nyreskade (dagenspharma.dk 1.3.2017).)

(Anm: Reflux and ulcer medications linked to kidney stones and chronic kidney disease. Certain medications commonly used to treat heartburn, acid reflux, and ulcers can have damaging effects on the kidneys. The findings come from two studies that will be presented at ASN Kidney Week 2016 November 15-20 at McCormick Place in Chicago, IL. Proton pump inhibitors (PPIs) and histamine receptor-2 (H2) blockers are commonly used to reduce gastric acid production. (…) Studies: Proton Pump Inhibitors, Histamine Receptor-2 Blockers and the Risk of Incident Kidney Stones (Abstract 931); Long Term Kidney Outcomes Among Proton Pump Inhibitors Users Without Intervening Acute Kidney Injury (Abstract 3495). (medicalnewstoday.com 23.11.2016).)

Protonpumpshämmare kopplat till njurskador
lakemedelsvarlden.se 17.4.2015
Användningen av protonpumpshämmare fördubblar antalet akuta njurskador bland äldre patienter visar en ny studie.

Biverkningen akut njurskada är väldigt ovanlig bland patienter som tar protonpumpshämmare, PPI, men samtidigt är det miljontals människor som använder medicin av den klassen.

En nypublicerad studie visade att risken för njurbiverkningar som ledde till sjukhusbesök fördubblades bland patienter över 66 år som tog magmedicinen. Totalt ingick 290 000 patienter som tog PPI och dessa jämfördes med lika många kontrollpersoner.

Akuta njurskador uppkom bland 13,49 per 1000 medicinanvändare och år jämfört med 5,46 per 1000 och år som inte använde PPI. Risken för akut interstitiell nefrit, som är ett allvarligt inflammatoriskt tillstånd i njuren, var också associerat med läkemedelsklassen.

Andra faktorer kan ha påverkat resultaten i studien som inte ger bevis för en direkt koppling mellan njurbiverkningar och PPI. Författarna anser ändå att risken för akuta njurskador ska beaktas och att användningen preparaten bör vara återhållsam.

Riskökningen för att få frakturer efter användningen av PPI har varit känd sedan länge. På senare tid har både observationsstudier och fallrapporter publicerats om allvarligare biverkningar som tillexempel en ökad kardiovaskulär mortalitet bland patienter som tar PPI tillsammans med acetylsalicylsyra. (…)

(Anm: Proton pump inhibitors are associated with risk of chronic kidney disease, study finds. BMJ 2016;352:i128 (Published 12 January 2016).)

(Anm: Kidney Impairment Decreases Blood Flow to the Brain, Boosting Risk of Stroke and Dementia (dgnews.docguide.com 6.8.2015).) 

(Anm: Chronic kidney disease may cause diabetes. A team from the University of Montreal Hospital Research Centre (CRCHUM) has discovered a novel link between chronic kidney disease and diabetes. When kidneys fail, urea that builds up in the blood can cause diabetes, concludes a study published today in the Journal of Clinical Investigation. (medicalnewstoday.com 16.8.2016).) (PDF)

(Anm: Abdominal Obesity Is More Closely Associated With Diabetic Kidney Disease Than General Obesity. Diabetes Care  2016 Aug; dc161025).) 

(Anm: Heartburn, stomach acid medication linked to serious kidney damage (medicalnewstoday.com 15.4.2016).)

(Anm: Kidney Function: What Do The Kidneys Do? Contents of this article: 1.Structure and function of the kidneys 2.Diseases of the kidney and their cause 3. Kidney dialysis and maintaining healthy kidneys. (medicalnewstoday.com 4.2.2016).)

(Anm: Structure of kidney failure patients' blood clots may increase their risk of early death. Dialysis patients may have altered blood clots that increase their risk of dying prematurely, according to a study appearing in the Journal of the American Society of Nephrology (JASN). (medicalnewstoday.com 9.1.2017).)

(Anm: IgA Nephropathy. What is IgA nephropathy? IgA nephropathy is a kidney disorder that occurs when IgA—a protein that helps the body fight infections—settles in the kidneys. After many years, the IgA deposits may cause the kidneys to leak blood and sometimes protein in the urine. (niddk.nih.gov).) 

(Anm: Even small reductions in kidney function may damage heart, blood vessels. Even small reductions in kidney function are associated with heart and blood vessel damage, according to new research in the American Heart Association's journal Hypertension. (medicalnewstoday.com 8.1.2016).)

- Syrepumpehemmere (protonpumpehemmere (PPI) knyttet til alvorlige gastrointestinale infeksjoner. (- Legemidler som protonpumpehemmere (PPI) knyttet til en økt risiko for tarminfeksjoner med C. difficile og Campylobacter bakterier som kan forårsake betydelig sykdom.)

Acid suppression medications linked to serious gastrointestinal infections (Syrepumpehemmere knyttet til alvorlige gastrointestinale infeksjoner)
medicalnewstoday.com 9.1.2017
I en populasjonsbasert studie fra Skottland ble bruk av vanlig foreskrevet syredempende legemidler som protonpumpehemmere (PPI) knyttet til en økt risiko for tarminfeksjoner med C. difficile og Campylobacter bakterier som kan forårsake betydelig sykdom. (In a population-based study from Scotland, use of commonly-prescribed acid suppression medications such as proton pump inhibitors (PPIs) was linked with an increased risk of intestinal infections with C. difficile and Campylobacter bacteria, which can cause considerable illness.)

Compared with individuals in the community who did not take acid suppression medications, those who did had 1.7-times and 3.7-times increased risks of C. difficile and Campylobacter, respectively. Among hospitalized patients, those using the medications had 1.4-times and 4.5-times increased risks, respectively.

Although acid suppression therapy is often considered relatively free from side effects, the findings suggest that there are significant adverse gastrointestinal consequences of their use. "Users of these medications should be particularly vigilant about food hygiene as the removal of stomach acid makes them more easily infected with agents such as Campylobacter, which is commonly found on poultry," said Prof. Thomas MacDonald, senior author of the British Journal of Clinical Pharmacology study.

(Anm: Acid suppression medications and bacterial gastroenteritis: a population-based cohort study. Br J Clin Pharmacol. 2017 (Published online 5 January 2017).)

(Anm: Autoimmunity and infections: When the body fights itself. Basel-based doctors are on the trail of a possible connection between autoimmune diseases and infections: errors can occur when immune cells absorb certain proteins from pathogen cells. These findings were reported in the journal PNAS by researchers from the Department of Biomedicine at the University of Basel and University Hospital Basel, as well as colleagues in the USA. (medicalnewstoday.com 9.1.2017).)

(Anm: Forskere advarer om overforbrug af protonpumpehæmmere. Ny litteraturgennemgang tyder på, at et stort antal patienter behandles med protonpumpehæmmere uden oplagt årsag og at en betydelig andel heraf kan udtrappes af medicinen uden en forværring af symptomer. Salget af protonpumpehæmmere (PPI) stiger fortsat støt. I primærsektoren er det totale salg af PPI de sidste 10 år således steget med 213 procent. Samtidigt er den gennemsnitlige individuelle mængde indløst PPI steget med 52 procent, så hver medicinforbruger i gennemsnit køber 224 døgndoser PPI på et år. Det fremgår af artiklen ‘behandling med protonpumpehæmmere (dagenspharma.dk 11.11.2015).)

- PRAC har utredet et signal om forhøyede nivåer av Kromogranin A ved bruk av protonpumpehemmere: dexlansoprazol; esomeprazol; lansoprazol; omeprazol; pantoprazol; rabeprazol.

Protonpumpehemmere – forhøyede nivåer av Kromogranin A
legemiddelverket.no 12.8.2016
PRAC har utredet et signal om forhøyede nivåer av Kromogranin A ved bruk av protonpumpehemmere: dexlansoprazol; esomeprazol; lansoprazol; omeprazol; pantoprazol; rabeprazol.
På bakgrunn av dette ber Legemiddelverket innehavere av alle relevante markedsføringstillatelser om å oppdatere sine preparatomtaler og pakningsvedlegg i henhold til anbefalingene fra PRAC.

Søknader om implementering av endringer skal klassifiseres i henhold til Europakommisjonens retningslinjer for klassifisering av endringer  og CMDhs artikkel 5 anbefalinger.

Endringen skal søkes innen 02.11.2016
Lenke til norsk oversettelse av anbefalt tekst finnes nedenfor. Det kreves ikke dokumentasjon for denne endringen.

Vi ber om at ingen nye endringer inkluderes ved innsendelse.

Merk: Brev til de enkelte innehavere av relevante markedsføringstillatelser vil ikke bli sendt i denne saken.

Endring i preparatomtale og pakningsvedlegg

Anbefaling fra PRAC

Norsk tekst for preparatomtale og pakningsvedlegg

(Anm: Kromogranin A. (…) Aktuelle indikasjoner. • Kan benyttes som biokjemisk markør i utredning og oppfølging av tumores med nevroendokrin differensiering:  ◦ Hypofysetumor, medullær tyroideacancer, paratyroideaadenom, carcinoid, feokromocytom, øycelletumor, gastrinom, neuroblastom og gastrointestinale nevroendokrine tumores • Utredning av uklare symptomer og tegn: ◦ Svingende hypertensjon ◦Uklare anfallstilstander ◦ Uavklart kronisk vandig diaré ◦ Flushing. (nevro.legehandboka.no).)

(Anm: Protonpumpehemmere og magekreft. Langtidsbivirkninger av medisiner kan overses i randomiserte, kontrollerte legemiddelutprøvninger fordi oppfølgingstiden er for kort. Vi har lenge visst at protonpumpehemmere gir magekreft hos gnagere, og det er ingen åpenbar biologisk grunn til at dette skulle være annerledes hos menneske. Tidsskr Nor Legeforen 2016; 136:13 (12.1.2016).)

(Anm: Even small reductions in kidney function may damage heart, blood vessels. Even small reductions in kidney function are associated with heart and blood vessel damage, according to new research in the American Heart Association's journal Hypertension. (medicalnewstoday.com 8.1.2016).)

(Anm: Stomach acid drugs linked to chronic kidney disease. Taking a class of drugs commonly used to reduce acid in the stomach is linked to a higher risk of developing chronic kidney disease, compared with not taking them. This was the finding of a new study led by the Johns Hopkins University in Baltimore, MD, and published in JAMA Internal Medicine. (medicalnewstoday.com 13.1.2016).)

(Anm: Proton pump inhibitors associated with risk of chronic kidney disease. Proton pump inhibitors (PPIs), which are commonly used drugs to reduce acid in the stomach, appear to be associated with an increased risk of chronic kidney disease but more research is needed to determine whether PPI use causes kidney damage, according to an article published online by JAMA Internal Medicine. (medicalnewstoday.com 11.1.2016).)

(Anm: Kidney Function: What Do The Kidneys Do? Contents of this article: 1.Structure and function of the kidneys 2.Diseases of the kidney and their cause 3. Kidney dialysis and maintaining healthy kidneys. (medicalnewstoday.com 4.2.2016).)

(Anm: IgA Nephropathy. What is IgA nephropathy? IgA nephropathy is a kidney disorder that occurs when IgA—a protein that helps the body fight infections—settles in the kidneys. After many years, the IgA deposits may cause the kidneys to leak blood and sometimes protein in the urine. (niddk.nih.gov).)

(Anm: Proton-Pump Inhibitors Are Associated with Chronic Kidney Disease Thomas L. Schwenk, MD reviewing Lazarus B et al. JAMA Intern Med 2016 Jan 11. Schoenfeld AJ and Grady D. JAMA Intern Med. 2016 (January 11, 2016) (NEJM 2016 (January 12, 2016).)

- Størrelsesorden og økonomisk effekt av overforbruk av antisekretorisk behandling i den ambulerende helsetjenesten. (- Konklusjon: Protonpumpehemmere er ofte for mye brukt i ambulerende omsorg uten dokumentert gyldig indikasjon. Feil bruk av protonpumpehemmere er forbundet med betydelige kostnader og med potensiale for bivirkninger.)

Magnitude and economic effect of overuse of antisecretory therapy in the ambulatory care setting. Størrelsesorden og økonomisk effekt av overforbruk av antisekretorisk behandling i den ambulerende helsetjenesten
Am J Manag Care. 2010 Sep;16(9):e228-34.
(…) OBJECTIVES: To determine the prevalence and economic effect of inappropriate proton pump inhibitor (PPI) use in an ambulatory care setting.

STUDY DESIGN: Retrospective medical record review of random sample with subgroup analysis.

METHODS: Patients were categorized according to appropriateness of pharmacotherapy based on documented upper gastrointestinal tract diagnoses, gastrointestinal or extraesophageal symptoms, or gastroprotection. Adverse events potentially associated with PPI use were identified.

RESULTS: Of 946 patients in an ambulatory care setting, 35.4% were given PPI therapy for an appropriately documented upper gastrointestinal tract diagnosis, 10.1% received PPIs empirically for symptomatic treatment based on extraesophageal symptoms, 18.4% received PPIs for gastroprotection, and 36.1% had no documented appropriate indication for PPI therapy. In a subgroup analysis, 48.6% of patients across all 4 categories received PPIs without documentation of reevaluation of upper gastrointestinal tract symptoms, accounting for 1034 patient-years of PPI use. The total cost of inappropriate PPI use was $233,994 based on over-the-counter PPI costs and $1,566,252 based on average wholesale price costs. Potentially related adverse events in this cohort included Clostridium difficile–associated diarrhea (6 cases) and community-acquired pneumonia (1 case), but no cases of hip fracture or vitamin B12 deficiency were identified.

Konklusjon: Protonpumpehemmere er ofte for mye brukt i ambulerende omsorg uten dokumentert gyldig indikasjoner. Feil bruk av protonpumpehemmere er forbundet med betydelige kostnader og med potensiale for bivirkninger. (…) (CONCLUSIONS: Proton pump inhibitors are often overused in the ambulatory care setting without documented valid indications. Inappropriate use of PPIs is associated with substantial cost expenditure and with the potential for adverse events.)

(Anm: Proton pump inhibitors should be used judiciously to minimize rare adverse events. Proton pump inhibitors (PPIs), commonly used for heartburn and gastric distress, should be prescribed at the lowest dose possible and for the shortest length of time because of potential side effects, according to a review in CMAJ (Canadian Medical Association Journal). "Proton pump inhibitors are associated with a number of rare but potentially serious adverse effects," writes Dr. Todd C. Lee, an internal medicine specialist in the Department of Medicine, McGill University Health Centre, Montréal, Québec, with coauthors. "These uncommon effects become highly relevant when considering the tens of millions of patients who take PPIs worldwide." (medicalnewstoday.com 23.11.2015).)

(Anm: Studier finner bekymrende over- og underforbruk av medisin på verdensbasis. (Studies find worrying over- and underuse of medicine worldwide. (…) The studies, commissioned by The Lancet journal and conducted by 27 international specialists, also found rates of Caesarian section deliveries are soaring - often in women who do not need them - while the simple use of steroids to prevent premature births has lagged for 40 years. (...) "A common tragedy in both wealthy and poor countries is the use of expensive and sometimes ineffective technology while low-cost effective interventions are neglected," the experts wrote in a statement about their findings. (...) Co-lead researcher Shannon Brownlee added: "Patients and citizens need to understand what's at stake here if their health systems fail to address these twin problems. In the U.S., we are wasting billions of dollars that should be devoted to improving the nation's health.") (reuters.com 8.1.2017).)

(Anm: Heartburn Drugs Tied to Higher Kidney Disease Risk. But studies weren't designed to prove proton pump inhibitors are responsible for the increase. -- A common type of heartburn medication called proton pump inhibitors (PPIs) seem to be linked with increased risk of chronic kidney disease, two new studies suggest. Prilosec, Nexium and Prevacid belong to this class of drugs, which treat heartburn  and acid reflux by lowering the amount of acid produced by the stomach. (…) "According to U.S. data, 90 percent of the prescriptions for PPI are not related to FDA-approved indications," he said. "We are using this medication right and left, and it may be counterproductive for many patients." (webmd.com 27.10.2015).)

(Anm: Findings by University of Michigan, colleagues and partners could lead to earlier detection for millions at risk for chronic kidney disease progression. University of Michigan researchers have identified an accessible, non-invasive way to identify patients at risk for progression of kidney disease. (…) People with early-stage chronic kidney disease tend to not notice any symptoms. Once detected, chronic kidney disease can be treated with medicines and lifestyle changes, including healthier food and beverage choices. These treatments usually decrease the rate at which chronic kidney disease worsens, but cannot prevent progression. (medicalnewstoday.com 3.12.2015).)

- Langtidsbrug af visse syrepumpehæmmere bekymrer forskere. (syrepumpehæmmere kan øge risikoen for bl.a. alvorlig hjertekarsygdom.)

Langtidsbrug af visse syrepumpehæmmere bekymrer forskere
dagenspharma.dk 11.5.2016
Længere tids brug af de almindeligt udbredte syrepumpehæmmere kan øge risikoen for bl.a. alvorlig hjertekarsygdom.

Ny forskning offentliggjort i tidsskriftet Circulation Research underbygger bekymringen for, at kronisk brug af de almindeligt udbredte syrepumpehæmmere kan øge risikoen for bl.a. alvorlig hjertekarsygdom. I laboratorieforsøg med humane endotelceller (fra indersiden af blodkar) har forskerne påvist, at langtidsbrug af syrepumpehæmmere, også kendt som protonpumpeinhibitorer som f.eks. Nexium (esomeprazol), accelererer aldringen af blodkar. Når forskerne […]

(Anm: Legemidler mot halsbrann gir tidlig aldring av blodkar. (Heartburn drug prematurely ages blood vessels. (…) A new study, published in Circulation Research, finds a potential mechanism to explain these negative health implications.) (medicalnewstoday.com 11.5.2016).)

- Halsbrann-piller i svangerskapet kan være knyttet til barndomsastma

Heartburn pills in pregnancy may be linked to childhood asthma
medicalnewstoday.com 11.1.2017
Children born to mothers who take heartburn medication during pregnancy may have a greater risk of developing asthma, research suggests.

Those whose mothers had been prescribed medicines to treat acid reflux during pregnancy were more likely to be treated for asthma in childhood, a review of studies found.

However, experts say the potential link - which came to light by reviewing studies that had examined health records - is not conclusive.

They say that the association could be caused by a separate, linked factor and that further research is needed to determine whether the medicines affect the health of children.

Mothers-to-be should follow existing guidelines - to use the medicines as required - and consult with a doctor or nurse if symptoms persist, they recommend. (…)

- Forsyth-forskning forklarer hvorfor populære syrenøytraliserende midler kan øke sjansen for benbrudd.

Forsyth research explains why popular antacids may increase chance of bone fractures (Forsyth-forskning forklarer hvorfor populære syrenøytraliserende midler kan øke sjansen for benbrudd)
medicalnewstoday.com 1.4.2015
Newly published research from the Forsyth Institute details a discovery explaining why the 100 million Americans estimated to be taking prescription and over-the-counter antacid and heartburn medications may be at an increased risk of bone fractures.

The new report from Forsyth, published in the March issue of the prestigious medical research journal PLOS Genetics, explains that stomach acid in the gastrointestinal tract plays an important role in helping the intestines absorb and transfer calcium to the skeletal system. While the introduction of proton pump inhibitor-based antacids reduces the level of acidity in the stomach to bring relief to patients, the reduction also interrupts and even stops the gut from absorbing much needed calcium.

The connection between proton pump inhibitors and bone fractures has been well established, with the Food and Drug Administration in 2010 requiring a warning label placed on all product packaging. Other research has indicated these medications may block the absorption of important nutrients, but until this study it was not known how or why this was happening in the body. (…)

(Anm: Benskjorhet. (mintankesmie.no/).)

Protonpumpshämmare minskar skyddet mot fraktur
lakemedelsvarlden.se 23.2.2011
Vanliga protopumpshämmare som omeprazol försämrar behandlingen mot benskörhet. Det visar en dansk studie.

Studien visar att patienter som behandlas med alendronat för osteoporos och som samtidigt använder protonpumpshämmare, som omeprazol och ezomeprazol har större risk för höftfrakurer än patienter som inte använder protonpumpshämmarna. (...)

- Long-term proton pump inhibitor (PPI) use and the development of gastric pre-malignant lesions.

Long-term proton pump inhibitor (PPI) use and the development of gastric pre-malignant lesions.
Cochrane Database Syst Rev. 2014 Dec 2;12:CD010623. [Epub ahead of print]
(...) BACKGROUND: Proton pump inhibitors (PPIs) are the most effective drugs to reduce gastric acid secretion. PPIs are one of the most commonly prescribed classes of medications worldwide. Apart from short-term application, maintenance therapy with PPIs is recommended and increasingly used in certain diseases, such as Zollinger-Ellison syndrome and gastro-oesophageal reflux disease, especially for people with erosive oesophagitis or Barrett's oesophagus. Although PPIs are generally safe, their efficacy and safety of long-term use remains unclear. The question of whether the long-term use of PPIs could promote the development of gastric pre-malignant lesions has been widely investigated, but results are inconsistent. Limited insight on this problem leads to a dilemma in decision making for long-term PPI prescription. (...)

AUTHORS' CONCLUSIONS: There is presently no clear evidence that the long-term use of PPIs can cause or accelerate the progression of corpus gastric atrophy or intestinal metaplasia, although results were imprecise. People with PPI maintenance treatment may have a higher possibility of experiencing either diffuse (simple) or linear/micronodular (focal) ECL cell hyperplasia. However, the clinical importance of this outcome is currently uncertain. (...)

(Anm: Legemidler mot halsbrann gir tidlig aldring av blodkar. (Heartburn drug prematurely ages blood vessels. (…) A new study, published in Circulation Research, finds a potential mechanism to explain these negative health implications.) (medicalnewstoday.com 11.5.2016).)

- Eosinofil øsofagitt: oppdatering av behandling og kontroverser.

(Anm: Eosinophilic esophagitis: update on management and controversies. Abstract Eosinophilic esophagitis is a chronic allergen driven immune mediated disease that is increasingly recognized as a leading cause of dysphagia and foregut symptoms in children and adults. Much knowledge has been gained in recent years on the genetic and environmental risk factors for this disease, the associated inflammatory milieu, and the long term complications from esophageal remodeling. In this review we will highlight recent progress made in research into this disease, focusing on adults. (…) Incidence and prevalence The incidence and prevalence of eosinophilic esophagitis have risen over the past two decades.168910 In a report from Olmstead County, Minnesota, USA, no cases were documented before 1990, and the incidence rose from 0.35 cases/100 000 people to 9.5 cases/100 000 people over a 15 year period.6 Increased incidence has also been reported in Switzerland,5 the Netherlands,11 and Denmark.12 The reasons for this increase are poorly understood, and increased recognition is probably not the only cause.56 (…) Gut microbiome The human microbiome has been the subject of intense research interest in recent years; however, there is still a paucity of data on the microbiome of the esophagus. (…) Clinical presentation Adults and children with eosinophilic esophagitis have different clinical presentations.84858687 Children commonly present with difficulty feeding, vomiting, abdominal pain, or failure to thrive, whereas adults typically have symptoms of dysphagia, heartburn, chest pain, and food impactions.208488 This difference is thought to be, at least in part, related to gradual esophageal tissue remodeling arising from unabated inflammation.89909192 An inflammatory phenotype—endoscopic features including white exudates, linear furrows, and edema—is thought to eventually evolve as a result of longstanding inflammation into a fibrostenotic phenotype, with fibrotic features on endoscopy such as rings, strictures, and a narrow caliber esophagus.899394 BMJ 2017;359:j4482 (Published 13 November 2017).)

(Anm: Allergisk betennelse i spiserøret - eosinofil øsofagitt. Allergisk betennelse i spiserøret gir plager som ligner på syreplager, men symptomene forsvinner ikke med syrehemmende behandling (nhi.no 15.11.2017).)

– The drug, dupilumab, was statistically significant in improving the ability to swallow in adults with moderate-to-severe eosinophilic esophagitis, when compared with a placebo.

(Anm: Regeneron-Sanofi drug succeeds mid-stage study. (Reuters) - Regeneron Pharmaceuticals Inc and Sanofi SA said on Monday their drug to treat inflammation in the esophagus, mainly caused by food allergies, met the main goal of a mid-stage study. The drug, dupilumab, was statistically significant in improving the ability to swallow in adults with moderate-to-severe eosinophilic esophagitis, when compared with a placebo. Eosinophilic esophagitis is a chronic, allergic inflammatory disease that damages the pipe that connects the throat and the stomach, and can lead to food getting stuck in the esophagus and difficulties in swallowing. The U.S. Food and Drug Administration in late-March approved dupilumab to treat adults with moderate-to-severe eczema. The drug is marketed under the trade name Dupixent, with a list price of $37,000 a year.  (reuters.com 16.10.2017).)

- Proton-Pump Inhibitors Might Be Associated with Pneumonia in Stroke Patients.

Proton-Pump Inhibitors Might Be Associated with Pneumonia in Stroke Patients
jwatch.org (December 11, 2014)
Routine prescribing of these drugs for “prophylaxis” is not warranted.

Allan S. Brett, MDIn some hospitals, stroke patients are routinely given acid-suppressive therapy with proton-pump inhibitors (PPIs) or histamine-2–receptor antagonists (H2RAs) for “prophylaxis,” despite no evidence to support this practice. In fact, acid-suppressive therapy could be harmful, because observational data in various patient populations suggest an association with elevated risk for pneumonia. In this retrospective study from a Boston teaching hospital, researchers sought to determine whether acid-suppressive therapy in stroke patients was associated with excess risk for hospital-acquired pneumonia. (...)

(Anm: Risk of community-acquired pneumonia and use of gastric acid-suppressive drugs. (…) CONCLUSION: Current use of gastric acid-suppressive therapy was associated with an increased risk of community-acquired pneumonia.JAMA. 2004 Oct 27;292(16):1955-60.)

- Legemidler mot halsbrann gir tidlig aldring av blodkar

Heartburn drug prematurely ages blood vessels
medicalnewstoday.com 19.5.2016
Many Americans who suffer from heartburn find relief from the discomfort by taking proton pump inhibitors - an over-the-counter medication. Although these drugs are widely used, concerns are mounting over their long-term effects on the body. Recent studies have demonstrated links between proton pump inhibitors and a range of health conditions. A new study, published in Circulation Research, finds a potential mechanism to explain these negative health implications.

Heartburn, also referred to as esophageal reflux or GERD, occurs when acid from the stomach finds its way into the esophagus.

The condition can be very unpleasant and, because proton pump inhibitors (PPIs) are easily available and clear up symptoms quickly, they have proven very popular.

According to the U.S. Food and Drug Administration (FDA), 1 in 14 Americans have used PPIs at least once. In 2006, an estimated $7 billion was spent on PPIs globally.

Esomeprazole, brand name Nexium, is one of the most commonly purchased PPIs. In 2015, Nexium created almost $2.5 billion of revenue for drug manufacturer AstraZeneca.

Because these drugs are so effective at relieving reflux, and because they do not require a prescription, they are used much more widely than initially predicted. PPIs were never approved for long-term use by regulatory authorities and recent studies have shown a number of worrying correlations.

Health problems related to PPIs
Heart disease, kidney disease, and dementia have all been linked to long-term PPI usage.

However, studies to date have only been able to demonstrate correlation, rather than causation. Also, until now, no known mechanism has been uncovered that can explain the findings.

Recent research, carried out by Dr. John P. Cooke at Houston Methodist Research Institute, TX, investigated a potential molecular mechanism by which PPIs might induce their negative health effects.

Dr. Cooke believes that premature aging of the endothelial cells that line the interior of blood vessels might be part of the answer.

The researchers investigated the role of two PPIs, one of which was Nexium. They found that prolonged exposure to the drugs led to premature biological aging of these vascular cells. (…)

- Mavesyremedicin kan føre til vitaminmangel.

Mavesyremedicin kan føre til vitaminmangel
dagenspharma.dk 19.12.2013
Brug af syrepumpehæmmmere i en længere periode er forbundet med en forhøjet risiko for B12 vitaminmangel. (...)

FDA Drug Safety Communication: Clostridium difficile-associated diarrhea can be associated with stomach acid drugs known as proton pump inhibitors (PPIs) (FDA Kommunikasjon legemiddelsikkerhet: Clostridium difficile-assosiert diaré kan være assosiert med magesyre-legemidler som kalles protonpumpehemmere (PPI-er))
fda.gov 2.8.2012
(...) Safety Announcement
[02-08-2012] The U.S. Food and Drug Administration (FDA) is informing the public that the use of stomach acid drugs known as proton pump inhibitors (PPIs) may be associated with an increased risk of Clostridium difficile–associated diarrhea (CDAD). A diagnosis of CDAD should be considered for patients taking PPIs who develop diarrhea that does not improve.

Patients should immediately contact their healthcare professional and seek care if they take PPIs and develop diarrhea that does not improve. (...)

(Anm: Study reveals how C. difficile disrupts the gut. (medicalnewstoday.com 23.2.2015).)

(Anm: Clostridium difficile-infeksjon (CDI) (fhi.no 23.7.2014).)

(Anm: Gastrointestinal dysbiosis and the use of fecal microbial transplantation in Clostridium difficile infection. World J Gastrointest Pathophysiol. 2015 Nov 15;6(4):169-80.)

(Anm: Complete Microbiota Engraftment Is Not Essential for Recovery from Recurrent Clostridium difficile Infection following Fecal Microbiota Transplantation. MBio. 2016 Dec 20;7(6). pii: e01965-16.)

(Anm: Research offers insights into Clostridium difficile (medicalnewstoday.com 21.8.2014).)

(Anm: Markkur-legemiddel kan behandle dødelig C. difficile infeksjon. (Deworming drugs could treat deadly C. difficile infection.) (medicalnewstoday.com 18.9.2016).)

(Anm: Clostridium difficile (CDI) (...) is a species of Gram-positive bacteria of the genus Clostridium that causes severe diarrhea and other intestinal disease when competing bacteria in the gut flora have been wiped out by antibiotics. (en.wikipedia.org).)

- PPI og risiko for hoftefraktur hos kvindelige rygere.

PPI og risiko for hoftefraktur hos kvindelige rygere
irf.dk 30.4.2012 (Institut for Rationel Farmakoterapi (IRF)
Kort om studiet
Prospektiv kohorteundersøgelse af 79.899 postmenopausale sygeplejersker i alderen 30-55 år, som i gennemsnit er fulgt i godt 7 år (1).

Den absolutte risiko for hoftefraktur var 2,02 tilfælde per 1.000 personnår (149 tilfælde/5.341 personer) i gruppen, der regelmæssigt havde taget protonpumpehæmmere (PPI) sammenlignet med 1,51 tilfælde per 1.000 personår (744 tilfælde/75.558 personer) hos dem, der ikke havde taget PPI.
Aldersjusteret hazard ratio (HR) var 1,35 (95 % sikkerhedsgrænser (CI) var 1,31 til 1,62).

Langvarig brug af PPI og rygning var associeret med øget risiko.

Blandt nuværende og tidligere rygere var brug af PPI associeret med mere end 50 % øget risiko for fraktur, HR 1,51 (CI 1,20 til 1,91).

Blandt kvinder, der aldrig havde røget var der ingen signifikant association, HR 1,06 (CI 0,77 til 1,46). (...)

- Proton Pump Inhibitors (PPIs) - Drug Safety Communication: Clostridum Difficile-Associated Diarrhea (CDAD) Can be Associated With Stomach Acid Drugs.

Proton Pump Inhibitors (PPIs) - Drug Safety Communication: Clostridum Difficile-Associated Diarrhea (CDAD) Can be Associated With Stomach Acid Drugs
fda.gov 8.2.2012
• AcipHex (rabeprazole sodium)
• Dexilant (dexlansoprazole)
• Nexium (esomeprazole magnesium)
• Omeprazole (omeprazole) Over-the-Counter (OTC)
• Prevacid (lansoprazole) and OTC Prevacid 24hr
• Prilosec (omeprazole) and OTC
• Protonix (pantoprazole sodium)
• Vimovo (esomeprazole magnesium and naproxen)
• Zegerid (omeprazole and Sodium bicarbonate) and OTC (...)

ISSUE: FDA notified the public that the use of stomach acid drugs known as proton pump inhibitors (PPIs) may be associated with an increased risk of Clostridium difficile–associated diarrhea (CDAD). A diagnosis of CDAD should be considered for patients taking PPIs who develop diarrhea that does not improve. The FDA is working with manufacturers to include information about the increased risk of CDAD with use of PPIs in the drug labels.

FDA is also reviewing the risk of CDAD in users of histamine H2 receptor blockers. H2 receptor blockers are used to treat conditions such as gastroesophageal reflux disease (GERD), stomach and small intestine ulcers, and heartburn. (...)

- PPIs raise fracture risk by 35%.

PPIs raise fracture risk by 35%
pulsetoday.co.uk 1.2.2012
Regular use of proton pump inhibitors is associated with an increased hip fracture risk - particularly in smokers - concludes a large US study.

The prospective cohort study looked at data from 79,899 postmenopausal women on their use of PPIs between 2000 and 2008, and found those who regularly used PPIs for at least two years the risk was 35% higher than non-users, even when adjusted for age.

The absolute risk of hip fracture was 2.02 events per 1000 person years in regular PPI users, compared with 1.51 events in non-users. PPI use in current or former smokers was associated with a 51% increase in fracture risk, while there was no association between PPI use and fracture risk in women who had never smoked. (...)

- Studien finner ingen sammenheng mellom PPI bruk og beinfrakturer hos pasienter med Barretts spiserør.

(Anm: Study finds no link between PPI use and bone fractures in patients with Barrett's esophagus. Proton pump inhibitors (PPIs)—medications commonly used to treat heartburn, acid reflux, and ulcers—have been linked with potentially serious side effects including a possible increased risk of bone fractures. In a new Alimentary Pharmacology & Therapeutics study, however, patients with Barrett's esophagus—a long-term complication of acid reflux— who took high doses of PPIs for prolonged periods were no more likely to have bone fractures or evidence of bone thinning (osteopenia or osteoporosis) than people in the general population. (news-medical.net 9.10.2017).)

Diverse artikler

(Anm: More Data to Inform the PPI−Dementia Controversy. Allan S. Brett, MD reviewing Goldstein FC et al. J Am Geriatr Soc 2017 Sep. In this latest study, proton-pump inhibitors were not associated with cognitive impairment. Patients continue to express concern about media reports stating that proton-pump inhibitor (PPI) use might cause cognitive impairment or dementia. In this latest study, researchers took advantage of prospectively collected data on 10,500 patients (mean age, 73) with normal cognition or mild cognitive impairment who were followed at 33 U.S. Alzheimer disease research centers. Participants underwent detailed structured cognitive assessments annually and were classified as using PPIs continuously, intermittently, or never. Follow-up ranged from 2 to 6 years. In analyses adjusted for confounding demographic and clinical variables, PPI use (continuous or intermittent) compared with no PPI use was associated with significantly lower risk for progression from normal cognition to mild cognitive impairment, and from mild cognitive impairment to dementia. Hazard ratios for progression were roughly 0.80 for these outcomes. Histamine-2–receptor antagonist use also was associated with lower risk for cognitive impairment. Comment
This study's strength is its robust longitudinal assessment of cognitive status at specialized research centers; in contrast, the first publicized study to suggest a PPI−dementia connection was derived from an administrative claims database with nonverified dementia diagnoses and inadequate adjustment for confounding variables (NEJM JW Gen Med Jun 15 2016 and JAMA Neurol 2016; 73:410). Although the protective effect of PPIs against cognitive decline found in the current study is difficult to explain, the findings provide reassurance that PPIs are unlikely to cause cognitive decline. A recent Finnish study with confirmation of dementia diagnoses reached similar conclusions (NEJM JW Gen Med Sep 15 2017 and J Gastroenterol 2017 Jul 11; [e-pub]). NEJM 2017 (October 12, 2017).)

(Anm: Bias [baies] -en, - skjevhet i vitenskapelig undersøkelse el. resultat pga. mangelfull systematikk i innsamlingen av data. Etym.: eng., fr. biais helning, tendens. Kilde: ordnett.no.)

(Anm: Bias; (...) valg og vurderinger som på systematisk måte avviker fra det som er faktisk korrekt. Kilde: Store norske leksikon.)

(Anm: Legemiddeletterlevelse (Tas legemidler som foreskrevet?) (Adherence to Medication.) (…) Legemidler virker ikke på pasienter som ikke tar dem. (Drugs don't work in patients who don't take them.)  (NEJM 2005;353:487-497(August 4).)

Proton Pump Inhibitors Raise Hip Fracture Risk Over Time
medscape.com 31.1.2012
January 31, 2012 — A new study strengthens the association of long-term use of proton pump inhibitors (PPIs) with increased risk for hip fracture in postmenopausal women, particularly those who smoke.

PPIs can affect fracture risk by increasing secretion of gastrin, inhibiting calcium absorption, and altering osteoclast function. Use of these drugs to treat indigestion increased when they became available over the counter in the United States in 2003. In May 2010, the US Food and Drug Administration issued a warning about the possible link between extended PPI use and hip fracture and requested further information. (...)

Use of proton pump inhibitors and risk of hip fracture in relation to dietary and lifestyle factors: a prospective cohort study
BMJ 2012;344:e372 (31 January)
Objective To examine the association between chronic use of proton pump inhibitors (PPIs) and risk of hip fracture. (...)

Results During 565 786 person years of follow-up, we documented 893 incident hip fractures. The absolute risk of hip fracture among regular users of PPIs was 2.02 events per 1000 person years, compared with 1.51 events per 1000 person years among non-users. Compared with non-users, the risk of hip fracture among women who regularly used PPIs for at least two years was 35% higher (age adjusted hazard ratio 1.35 (95% confidence interval 1.13 to 1.62)), with longer use associated with increasing risk (Ptrend<0.01). Adjustment for risk factors, including body mass index, physical activity, and intake of calcium did not materially alter this association (hazard ratio 1.36 (1.13 to 1.63)). These associations were also not changed after accounting for reasons for PPI use. The relation between PPI use and fracture differed by smoking history (Pinteraction=0.03). Among current and former smokers, PPI use was associated with greater than 50% increase in risk of fracture, with a multivariate hazard ratio for fracture of 1.51 (1.20 to 1.91). In contrast, among women who never smoked there was no association (multivariate hazard ratio 1.06 (0.77 to 1.46)). In a meta-analysis of these results with 10 prior studies, the pooled odds ratio of hip fracture associated with PPI use was 1.30 (1.25 to 1.36).

Conclusion Chronic use of PPIs is associated with increased risk of hip fracture, particularly among women with a history of smoking. (...)

Children, Asthma, and Proton Pump Inhibitors
Editorial
JAMA. 2012;307(4):406-407 (January 25)
(...) In conclusion, the study by Holbrook et al in this issue of JAMA indicates that chronic use of PPIs does not improve symptom control in children with asthma. Moreover, the observation that such use might be associated with serious adverse effects should suggest great caution in prescribing PPIs in general pediatric practice. (...)

Proton pump inhibitors and risk of fractures: a meta-analysis of 11 international studies
Am J Med. 2011 Jun;124(6):519-26.
BACKGROUND: Concerns have been raised about the risk of fractures with acid-suppressive medications, such as proton pump inhibitors and histamine(2)-receptor antagonists. (...)

CONCLUSION: In this meta-analysis of observational studies, proton pump inhibitors modestly increased the risk of hip, spine, and any-site fractures, whereas histamine(2)-receptor antagonists were not associated with fracture risk. The possibility of residual confounding cannot be excluded. Further skeletal evaluation should be considered for patients who are taking proton pump inhibitors and also at risk for osteoporotic fracture. (...)

Proton pump inhibitor use and risk of adverse cardiovascular events in aspirin treated patients with first time myocardial infarction: nationwide propensity score matched study
BMJ 2011; 342:d2690 (11 May)
Objective To examine the effect of proton pump inhibitors on adverse cardiovascular events in aspirin treated patients with first time myocardial infarction. (...)

Conclusion In aspirin treated patients with first time myocardial infarction, treatment with proton pump inhibitors was associated with an increased risk of adverse cardiovascular events. (...)

(Anm: Aspirin: is it really a 'wonder drug'? (medicalnewstoday.com 29.10.2015).)

(Anm: Aspirin not an effective treatment for atrial fibrillation, study suggests. New research suggests that aspirin may not be as effective as previously believed for treating patients with atrial fibrillation. In fact, for patients who had a catheter ablation to lower their risk of stroke, the risks of using aspirin may outweigh the benefits. (…) In fact, the American College of Cardiologists report that more than 1 in 3 patients with A-fib who have an "intermediate-to-high" risk of stroke are treated with aspirin instead of oral blood thinners, even when medical guidelines advise the use of anticoagulants. (medicalnewstoday.com 15.5.2017).)

- Hvorfor aspirin kan være farlige for eldre mennesker.

(Anm: Why Aspirin May Be More Dangerous for Older People. (…) Studies have shown that low doses of the blood-thinner can significantly lower the risk of heart problems, especially among people who have already had a heart attack or stroke. But in a study published in the Lancet, researchers say that the risks of aspirin haven’t been properly studied in older people. Most of the studies showing the over-the-counter drug’s benefits have included younger people under 65 years. However, most people who are currently taking daily aspirin for their heart are older. (time.com 14.6.2017).)

(Anm: Bleeding Risks With Aspirin Use for Primary Prevention in Adults: A Systematic Review for the U.S. Preventive Services Task Force. (…) Conclusion: Consideration of the safety of primary prevention with aspirin requires an individualized assessment of aspirin's effects on bleeding risks and expected benefits because absolute bleeding risk may vary considerably by patient.Ann Intern Med. 2016 Apr 12. [Epub ahead of print].)

(Anm: Aspirin Therapy Fails to Reduce ARDS. —Rate at 7 days unchanged. (…) SAN FRANCISCO -- Initiating aspirin therapy to emergency room patients at risk of lung injury does not influence the chance that these patients will experience acute respiratory distress syndrome (ARDS), researchers reported here. (medpagetoday.com 17.5.2016).)

(Anm: OTC Antacids Linked to Bleeding Risk: The Pain Medicine News Report. Over-the-counter antacids that contain aspirin may increase the risk of serious bleeding, according to FDA reports. (medpagetoday.com 23.6.2016).)

(Anm: Antacid. An antacid is a substance which neutralizes stomach acidity, which in turn relieves heartburn, indigestion or stomach upset.[1] (en.wikipedia.org).)

Study questions heartburn drugs for kids
reuters.com 5.4.2011
NEW YORK (Reuters Health) - Acid-suppressing drugs like Prilosec and Prevacid may not be much help for infants with troublesome acid reflux, and there's too little evidence that they help older children and teenagers, a new research review concludes.

The findings, reported in the journal Pediatrics, question the usefulness of so-called proton-pump inhibitors in children with gastroesophageal reflux disease, or GERD.
The drugs, which suppress stomach-acid production, have names like omeprazole (Prilosec), lansoprazole (Prevacid) and esomeprazole (Nexium). Prilosec and Prevacid are both available over the counter, and typically cost about 50 cents per pill. Nexium is still only available by prescription, and is more expensive.

In the new study, the researchers reviewed 12 clinical trials that tested the medications for treating GERD in infants, children or teenagers.
They found no good evidence that the drugs eased acid-reflux symptoms in infants -- such as crying and "fussing" after being fed. (...)

Proton Pump Inhibitor drugs (PPIs): Drug Safety Communication - Low Magnesium Levels Can Be Associated With Long-Term Use
fda.gov 2.3.2011
Prescription PPIs include Nexium (esomeprazole magnesium), Dexilant (dexlansoprazole), Prilosec (omeprazole), Zegerid (omeprazole and sodium bicarbonate), Prevacid (lansoprazole), Protonix (pantoprazole sodium), AcipHex (rabeprazole sodium), and Vimovo (a prescription combination drug product that contains a PPI (esomeprazole magnesium and naproxen).

Over-the-counter (OTC) PPIs include Prilosec OTC (omeprazole), Zegerid OTC (omeprazole and sodium bicarbonate), and Prevacid 24HR (lansoprazole). (...)

ISSUE: FDA notified healthcare professionals and the public that prescription proton pump inhibitor (PPI) drugs may cause low serum magnesium levels (hypomagnesemia) if taken for prolonged periods of time (in most cases, longer than one year). Low serum magnesium levels can result in serious adverse events including muscle spasm (tetany), irregular heartbeat (arrhythmias), and convulsions (seizures); however, patients do not always have these symptoms. Treatment of hypomagnesemia generally requires magnesium supplements. In approximately one-quarter of the cases reviewed, magnesium supplementation alone did not improve low serum magnesium levels and the PPI had to be discontinued.

BACKGROUND: PPIs work by reducing the amount of acid in the stomach and are used to treat conditions such as gastroesophageal reflux disease (GERD), stomach and small intestine ulcers, and inflammation of the esophagus. (...)

Protonpumpshämmare minskar skyddet mot fraktur
lakemedelsvarlden.se 23.2.2011
Vanliga protopumpshämmare som omeprazol försämrar behandlingen mot benskörhet. Det visar en dansk studie.

Studien visar att patienter som behandlas med alendronat för osteoporos och som samtidigt använder protonpumpshämmare, som omeprazol och ezomeprazol har större risk för höftfrakurer än patienter som inte använder protonpumpshämmarna. (...)

Opportunities to Decrease Inappropriate Uses of Proton Pump Inhibitors (Muligheter for å redusere uhensiktsmessig bruk av protonpumpehemmere)
Arch Intern Med. 2011 (Published online February 14)
The May 2010 issue of the Archives included 3 articles on the harms of PPIs: Gray et al1 showed that PPI were associated with an increase in the rate of spine, lower arm, and total fractures; Howell et al2 showed that PPI increased the risk of Clostridium difficile infection; and Linsky et al3 showed that PPI also increased the recurrence of C difficile infection. We deliberately grouped these articles together because we wanted to draw attention to the adverse effects of these drugs given data showing that 53% to 69% of PPI prescriptions are for inappropriate indications.4-6 (...)

Use of acid-suppressive drugs and risk of pneumonia: systematic review and meta-analysis
CMAJ 2010 8 (Published online ahead of print December 20)
Background: Observational studies and randomized controlled trials have yielded inconsistent findings about the association between the use of acid-suppressive drugs and the risk of pneumonia. We performed a systematic review and meta-analysis to summarize this association. (...)

Interpretation: Use of a proton pump inhibitor or histamine2 receptor antagonist may be associated with an increased risk of both community- and hospital-acquired pneumonia. Given these potential adverse effects, clinicians should use caution in prescribing acid-suppressive drugs for patients at risk. (...)

(Anm: pneumoni; det samme som lungebetennelse. Kilde: Store norske leksikon.)

(Anm: pneumoni; pnevmoni; pneumonia, infeksjon der lungealveolane blir fylte med betennelseseksudat som blir til fortetning (konsolidasjon, jf hepatisasjon) slik som ved kruppøs pneumoni, eller infeksjon som også sit i luftvegsgreinene slik som ved bronkopneumoni eller som helst er i sjølve lungevevet (interstitielt); jf andre oppslag på pneumonia; dessutan: aspirasjonspneumoni, kjempecellepneumoni (Hechts pneumoni), Løfflers pneumoni, hypostatisk pneumoni, influensaviruspneumoni, interstitiell pneumoni, organiserande pneumoni; sjå også Klebsiella pneumoniae; e.n. lungebrune, lungebrann, lungekolda EN pneumoni ET [gr pneumonia]. Kilde: Norsk medisinsk ordbok.)

Proton-pump inhibitors are associated with increased cardiovascular risk independent of clopidogrel use: a nationwide cohort study.
Ann Intern Med. 2010 Sep 21;153(6):378-86.
BACKGROUND: Controversy remains on whether the dual use of clopidogrel and proton-pump inhibitors (PPIs) (...)

(...) CONCLUSION: Proton-pump inhibitors seem to be associated with increased risk for adverse cardiovascular outcomes after discharge, regardless of clopidogrel use for myocardial infarction. Dual PPI and clopidogrel use was not associated with any additional risk for adverse cardiovascular events over that observed for patients prescribed a PPI alone. Primary Funding Source: The Danish Medical Research Council and the Danish Heart Foundation. (...)

Proton Pump Inhibitors (PPIs)
fda.gov 9.8.2010
The FDA is revising the prescription and over-the-counter (OTC) labels for proton pump inhibitors to include new safety information about a possible increased risk of fractures of the hip, wrist, and spine with the use of these medications.

The new safety information is based on FDA's review of several epidemiological studies. Some studies found that those at greatest risk for these fractures received high doses of proton pump inhibitors or used them for one year or more. The majority of the studies evaluated individuals 50 years of age or older and the increased risk of fracture primarily was observed in this age group. As a precaution, the "Drug Facts" label on the OTC proton pump inhibitors (indicated for 14 days of continuous use) also is being revised to include information about this risk. (...)

FDA revises labels on stomach drugs over bone break risks (FDA reviderer preparatomaler for legemidler som nedsetter syresekresjon grunnet risiko for benbrudd)
pharmatimes.com 26.5.2010
(...) The US Food and Drug Administration has changed the labels on PPIs, to include the possible increased risk of fractures of the hip, wrist and spine with high doses or long-term use of the drugs. They are used to treat gastroesophageal reflux disease, stomach and small intestine ulcers, and inflammation of the esophagus, as well as over-the-counter treatments for frequent heartburn

The FDA noted that drugs which will be affected by the label change include Protonix (pantoprazole), Nexium (esomeprazole) and AstraZeneca’s older treatment Prilosec (omeprazole), as well as Takeda’s Dexilant (dexlansoprazole) and Prevacid (lansoprazole), plus Johnson & Johnson’s Aciphex (rabeprazole). (...)

Behandling med PPI kan öka frakturrisk varnar FDA
lakemedelsvarlden.se 26.5.2010
Den amerikanska läkemedelsmyndigheten FDA har gått ut med en varning där man vill uppmärksamma på sambandet mellan långvarig användning av protonpumpshämmare och en ökad frakturrisk.

På tisdagen publicerade FDA ett meddelande på sin hemsida om att den kan finnas en risk för frakturer för patienter som behandlas en längre tid med protonpumpshämmare, PPI. (...)

Protonpumpehemmere uten resept
H L Waldum
Tidsskr Nor Legeforen 2010; 130:1014 (20.5.2010)
Jeg leste med undring Hatlebakk og medarbeideres emosjonelle kommentar i Tidsskriftet nr. 6/10 (1) til mitt innlegg om protonpumpehemmere solgt uten resept (2). Det kan synes som om de overhodet ikke kjenner til den danske studien som viste at friske, symptomfrie medisinstudenter får dyspepsi etter bruk av protonpumpehemmere (3) på grunn av økt syresekresjon (4). Allikevel hevder de at den kliniske betydning av tilbakefall med hypersekresjon av syre (acid rebound) ikke er vist (1). Hvorfor skulle ikke den økte syresekresjonen forverre reflukssykdommen der det på forhånd er en funksjonell defekt i ventilfunksjonen i cardia når den gir reflukssymptomer hos friske? Er ikke tilbakefall med hypersekresjon av syre den mest sannsynlige årsaken til den påfallende økningen i reflukssykdom man har sett de siste tiåene? (...)

Overuse of heartburn drugs is risky: study (Overforbruk av legemidler mot halsbrann er risikabelt ifølge studie)
reuters.com 10.5.2010
(Reuters) - Although they are sometimes used to make spicy meals go down easier, common heartburn drugs can cause serious side effects and should be used with caution, a series of studies released on Monday suggests.

Well-known brands of the drugs -- called proton pump inhibitors or PPIs -- include AstraZeneca's Nexium and Prilosec. Formerly AstraZeneca's biggest seller, Prilosec is available generically as omeprazole and is also sold over the counter by Procter & Gamble Co.

While the drugs are a great help to the right patients, they can raise the risk of fractures in post-menopausal women and cause bacterial infections in many patients, according to a special report in the Archives of Internal Medicine. (...)

(Anm: Benefits of Proton Pump Inhibitors May Not Justify the Risks for Many Users. Arch Intern Med. 2010;170(9):747-748 (May 10).)

How Safe Are Popular Reflux Drugs? (Hvor sikre er populære legemidler mot reflukssykdom?)
medicinenet.com 4.11.2009
(HealthDay News) -- Millions of Americans take drugs like Nexium, Prevacid and Prilosec to ease the erosive effects of acid reflux, but do these medicines put patients at risk for other health problems?

Experts remain divided on the potential dangers these common prescription medications might pose.

The drugs belong to a class of pharmaceuticals called "proton pump inhibitors," or PPIs, which are generally considered safe and effective. But lately these acid-reducing medications have been the subject of studies linking their use to a number of health risks, from an increased rate of hip fracture to a greater likelihood of diarrhea and community-acquired pneumonia.

Dr. Kenneth W. Altman, an associate professor of otolaryngology at Mount Sinai School of Medicine in New York City, draws attention to some of the potential consequences of PPI use in a commentary published in the November issue of Otolaryngology -- Head and Neck Surgery. (...)

(Anm: Unexpected consequences of proton pump inhibitor use. Otolaryngology - Head and Neck Surgery 2009;141(5):564-566 (November).)

Protonpumpehemmere kan redusere effekten av klopidogrel
legemiddelverket.no 5.6.2009
Ved samtidig bruk av visse protonpumpehemmere og klopidogrel, kan effekten av klopidogrel reduseres. Dette kan føre til økt risiko for tromboser, inkludert hjerteinfarkt eller hjerneslag. (...)

Klopidogrel hemmer blodplateaggregasjonen og benyttes forebyggende ved ulike aterotrombotiske hendelser, som hjerteinfarkt og hjerneslag. I EU er det markedsført flere klopidogrelholdige legemidler. I Norge er det foreløpig bare ett legemiddel på markedet, Plavix (Sanofi Pharma Bristol-Myers Squibb). Som bivirkning kan klopidogrel selv forårsake halsbrann og magesår. Derfor bruker mange pasienter samtidig protonpumpehemmere (“proton pump inhibitor”, PPI) for å unngå eller redusere slike symptomer. (...)

(Anm: Legemidler mot halsbrann gir tidlig aldring av blodkar. (Heartburn drug prematurely ages blood vessels. (…) A new study, published in Circulation Research, finds a potential mechanism to explain these negative health implications.) (medicalnewstoday.com 11.5.2016).)

(Anm: Bare én av ti nordmenn som rammes av hjerneslag får behandling i tide (tv2.no 16.2.2014).)

(Anm: – Får du hjerneslag har du dårlig tid. Dersom du rammes av hjerneslag risikerer du å miste to millioner hjerneceller hvert minutt. Får du ikke behandling innen 4,5 timer, er risikoen for invaliditet og uførhet stor. (…) Slagambulanse med CT. (nrk.no 8.2.2016).)

(Anm: Ja til ny akuttmetode: Flere slagpasienter kan få tilbud om å «fiske ut» blodpropp av hjernen. To år etter mange andre land gis det nå klarsignal til å videreføre ny og effektiv behandlingsmetode for slagpasienter. I fjor fikk bare 150 pasienter inngrepet - som opptil tusen kan ha nytte av hvert år. (aftenposten.no 2.5.2017).)

(Anm: - Plutselig oppstått dobbeltsyn (- Visuelle komplikasjoner er vanlig etter hjerneslag) Sudden onset double vision BMJ 2014;348:g3286 (19 May 2014).)

(Anm: En av tre blev dement efter återkommande stroke. (…) Den nya analysen, som publiceras i dag, torsdag, på tidskriften Lancet Neurologys hemsida, baseras på 22 sjukhusstudier och åtta populationsstudier. Undersökningarna är utförda mellan 1950 och 2009. (dagensmedicin.se 24.9.2009).)

Myndighet varnar för Plavix och protonpumpshämmare
dagensmedicin.se 3.6.2009
Det tromboshämmande läkemedlet Plavix och protonpumpshämmare som Losec och Lanzo bör inte användas samtidigt, varnar Läkemedelsverket.

Läs även: Plavix och magsyrahämmare ökade risken för hjärtdöd

Att både ta klopidogrel och protonpumpshämmare ökar risken för att dö eller få hjärtinfarkt. Protonpumpshämmarna, som används mot bland annat magsår och sura uppstötningar, tycks motverka den effekt som klopidogrel har. (...)

Common Drugs Boost Pneumonia Risk at Hospitals (Vanlige legemidler øker risiko for pneumoni på sykehus)
ivanhoe.com 1.6.2009
(Ivanhoe Newswire) – Hospitalized patients who are given acid-suppressive medications are 30 percent more likely to develop pneumonia during their hospital stay, a new study found. (...)

Fifty-two percent of the patients were given acid-suppressive medications, which included any order for a proton-pump inhibitor or histamine2 receptor antagonist. Of that group, 83 percent received proton-pump inhibitors, 23 percent received histamine2 receptor antagonist and some received both. (...)

(Anm: Acid-Suppressive Medication Use and the Risk for Hospital-Acquired Pneumonia. JAMA. 2009;301(20):2120-2128 (May 27).)

(Anm: pneumonia; pneumoni; (SML-artikkel) det samme som lungebetennelse. Kilde: Store norske leksikon.)

(Anm: Bacterial Pneumonia: Get the Facts (medicalnewstoday.com 26.8.2016).)
(Anm: Mycoplasma Pneumoniae: What You Need to Know (medicalnewstoday.com 26.8.2016).)

(Anm: Inflammatory markers linked with an increased risk of premature death in adults with COPD (medicalnewstoday.com 18.3.2015).)

Long term use of proton pump inhibitors raises risk of osteoporosis (Langtidsbruk av protonpumpehemmere øker risiko for benskjørhet)
BMJ 2008;337:a1272 (13 August 2008)
Patients who use proton pump inhibitors for seven or more years to treat reflux, peptic ulcers, and other conditions are at more risk of fractures related to osteoporosis, a large Canadian study has found (CMAJ 2008;179:319-26, doi: 10.1503/cmaj.071330). (...)

Proton Pump Inhibitors Over Years Increase Osteoporotic Fracture Risks
medpagetoday.com 12.8.2008
WINNIPEG, Manitoba, Aug. 12 -- Chronic use of proton pump inhibitors over years for gastroesophageal acid reflux is associated with osteoporotic fractures but short-term use seems to be safe, researchers here found. (...)

Proton pump inhibitors may be linked to rise in C difficile associated diarrhoea
BMJ 2008;337:a823 (15 July)
Proton pump inhibitors may be linked to rise in C difficile associated diarrhoea: Restricting the use of proton pump inhibitors may be a way to control Clostridium difficile associated diarrhoea, say researchers, who note that its prevalence has grown in tandem with an increase in use of the drugs, much of which, they say, is inappropriate (Journal of Hospital Infection doi: 10.1016/j.jhin.2008.04.023). (...)

Dobling av unge som bruker magesårmedisin
apotek.no 31.3.2008
Apotekforeningens månedsstatistikk mars 2008

Forbruket av legemidler mot magesår og andre syrerelaterte lidelser er doblet fra 2003 til 2007 blant ungdom i aldersgruppen 10-19 år. Økningen fortsetter i 2008, og forbruket de to første månedene i år er 27 prosent høyere enn samme periode i fjor. Fra 2006 til 2007 økte bruken med 21 prosent. (...)

(De mest kjente legemidlene i denne gruppen er Losec (omeprazol) og Zantac (rantidin).) (...)

An old problem
BMJ 2008;336:109 (19 January)
Overprescribing PPIs
Forgacs and Loganayagam described the problem of overprescribing proton pump inhibitors (PPIs).1 In June 2002 we wrote to many journals—and were ignored—about long term side effects being identified in general practice and surgery patients, with the then extensive, long term use of PPIs. At the time we shared an increasing number of patients with dependence on PPIs who experienced acute, severe gastritis and gastro-oesophageal reflux if they suddenly stopped or missed their PPIs; some showed refractory gastroparesis and severely delayed jejuno-ileal and colonic peristalsis when trying to reduce or stop their treatment after taking the PPI for extended periods (>3-60 months). (...)

(Anm: Can doctors reduce harmful medical overuse worldwide? BMJ 2014;349:g4289 (Published 03 July 2014).)

Overprescribing proton pump inhibitors
Editorials
BMJ 2008;336:2-3 (5 January)
Is expensive and not evidence based (...)

FDA Reviews Two Major Heartburn Drugs
forbes.com 10.12.2007
WASHINGTON - Patients who suffer from heartburn are not at increased risk for heart problems as a result of taking Prilosec or Nexium, according to a review released Monday by the Food and Drug Administration. (...)

Syrehemmere gir økt risiko for pneumoni
Tidsskr Nor Lægeforen 2007; 127: 1919
Behandling med protonpumpehemmere er forbundet med økt risiko for utvikling av pneumoni. (...)

(Anm: pneumoni; pnevmoni; pneumonia, infeksjon der lungealveolane blir fylte med betennelseseksudat som blir til fortetning (konsolidasjon, jf hepatisasjon) slik som ved kruppøs pneumoni, eller infeksjon som også sit i luftvegsgreinene slik som ved bronkopneumoni eller som helst er i sjølve lungevevet (interstitielt); jf andre oppslag på pneumonia; dessutan: aspirasjonspneumoni, kjempecellepneumoni (Hechts pneumoni), Løfflers pneumoni, hypostatisk pneumoni, influensaviruspneumoni, interstitiell pneumoni, organiserande pneumoni; sjå også Klebsiella pneumoniae; e.n. lungebrune, lungebrann, lungekolda EN pneumoni ET [gr pneumonia]. Kilde: Norsk medisinsk ordbok.)

F.D.A. Is Reviewing Heartburn Drugs After Studies Find Possible Heart Risk
nytimes.com 10.8.2007
WASHINGTON, Aug. 9 — Two small studies of the popular heartburn drugs Prilosec and Nexium found that patients who took the medicines over many years had an increased risk of sometimes fatal heart attacks and heart failure.

But officials at the Food and Drug Administration played down the heart worries, saying that other studies suggested no such risks. The F.D.A. will need another three months to complete a thorough analysis of the drugs’ safety, the officials said in an announcement on Thursday. (...)

FDA safety review on Nexium and Prilosec hits AstraZeneca stock
pharmatimes.com 10.8.2007
AstraZeneca shares have taken a tumble after health regulators in the USA and in Canada revealed that they are conducting safety reviews of the blockbuster antiulcerants Nexium and Prilosec, even though findings thus far suggest that the drugs do not increase the risk of heart trouble.

The process began at the end of May when AstraZeneca sent the US Food and Drug Administration, and other regulatory authorities worldwide, a preliminary review of new data from two small long-term clinical studies of Nexium (esomeprazole) and Prilosec (omeprazole) in patients with severe gastroesophageal reflux disease (GERD). Patients were randomised to receive either drug or to have surgery to control their GERD and the results from the 14-year study of Prilosec and five-year analyses from an ongoing study of Nexium “raised concerns that long-term use” of both drugs “may have increased the risk of heart attacks, heart failure, and heart-related sudden death...compared to patients who received surgery”, the FDA stated. (...)

(Anm: 'Sudden Adult Death' May Have Mitochondrial Origin. —Some cases of unexplained sudden death can be traced to a common mitochondrial defect. (medpagetoday.com 22.4.2015).)

(Anm: Mitochondria (mitokondrie) (mitokondriesykdommer) (mitokondrielle sykdommer). (mintankesmie.no).)

(Anm: Linking telomere loss and mitochondrial dysfunction in chronic disease. (…) Drawing a mechanistic connection between telomere function and mitochondria biology will provide a broader perspective for understanding the pathophysiology of diseases and their relation to the aging process, and may provide opportunities for new possible treatments. Front Biosci (Landmark Ed). 2017 Jan 1;22:117-127.)

(Anm: Extreme short and long telomeres linked to increased cancer risk (news-medical.net 5.4.2017).)

(Anm: Scientists discover master regulator of cellular aging. (…) "Telomeres represent the clock of a cell," said TSRI Associate Professor Eros Lazzerini Denchi, corresponding author of the new study, published online in the journal Science. "You are born with telomeres of a certain length, and every time a cell divides, it loses a little bit of the telomere. Once the telomere is too short, the cell cannot divide anymore." (medicalnewstoday.com 13.1.2017).)

(Anm: Betennelser endrer mitokondrier til giftige fabrikker. Å lære hvordan å kontrollere betennelser kan ha store implikasjoner for behandlingen av mange sykdommer. Banebrytende forskning oppdager hvordan makrofager endrer mitokondriene til giftige kjemisk-produserende betennelsespromotører. (Inflammation turns mitochondria into toxic factories. Learning how to control inflammation could have huge implications for the treatment of many diseases. Breaking research discovers how macrophages turn mitochondria into toxic chemical-producing inflammation-promoters.) (medicalnewstoday.com 25.9.2016).)

(Anm: Research may show new ways to repress inflammation at outset. (…) Professor Alexander Weber of the Interfaculty Institute of Cell Biology says the enzyme - Bruton's tyrosine kinase or BTK - is switched on when an inflammation occurs in the body, playing a key role in the inflammation's subsequent development. (medicinenet.com 21.2.2017).)

(Anm: Ørsmå mitokondrier spiller en svært stor rolle mht. menneskets evolusjon og sykdom (Tiny mitochondria play outsized role in human evolution and disease.) (medicalnewstoday.com 25.9.2015).)

Stomach drugs 'may weaken bones'
bbc.co.uk 27.12.2006
Hip fractures are more common among the elderly
Long-term use of some of the most common drugs prescribed to tackle stomach acid problems may be weakening people's bones. (...)

Study Links Heartburn Drugs, Broken Hip
forbes.com 26.12.2006
Taking such popular heartburn drugs as Nexium, Prevacid or Prilosec for a year or more can raise the risk of a broken hip markedly in people over 50, a large study in Britain found.

The study raises questions about the safety of some of the most widely used and heavily promoted prescription drugs on the market, taken by millions of people.

The researchers speculated that when the drugs reduce acid in the stomach, they also make it more difficult for the body to absorb bone-building calcium. That can lead to weaker bones and fractures.

Hip fractures in the elderly often lead to life-threatening complications. As a result, doctors should make sure patients have good reason to stay on heartburn drugs long term, said study co-author Dr. Yu-Xiao Yang of the University of Pennsylvania School of Medicine.

"The general perception is they are relatively harmless," Yang said. "They often are used without a clear or justified indication for the treatment." (...)

Long-term Proton Pump Inhibitor Therapy and Risk of Hip Fracture
JAMA 2006;296:2947-2953 (December 27)
(...) Conclusion Long-term PPI therapy, particularly at high doses, is associated with an increased risk of hip fracture. (...)

Proton-Pump Inhibitors and Hypomagnesemic Hypoparathyroidism
N Engl J Med 2006; 355:1834-1836 (October 26)
To the Editor: We report two cases of hypomagnesemic hypoparathyroidism associated with the use of proton-pump inhibitors, in which patients presented with carpopedal spasm in association with severe hypomagnesemia and hypocalcemia without an appropriate increase in the level of parathyroid hormone.

Patient 1 was a 51-year-old premenopausal woman who had been taking omeprazole for more than a year (at a dose of 20 mg twice daily) and who presented with carpopedal and truncal spasm. She began receiving 2.4 g of elemental calcium per day and, later, high-dose magnesium (Figure 1A). Fourteen months later, omeprazole was discontinued, and ranitidine . . . [Full Text of this Article] (...)

(Anm: hypoparatyreoidisme; nedsett funksjon i biskjoldkjertlane, d e skort på paratyreoideahormonet (PTH); fører til fall i kalsiuminnhaldet i blod; dette kan føra til muskelkrampar (tetani (s d)), grå stær, beinvevsforandringar m v; årsak har ofte vore tilfeldig fjerning av paratyreoidkjertlane ved strumaoperasjon men genetiske feil med hormonet eller hormonet sin reseptor, ev med den kalsiumsansande reseptoren e a kan gi ulike former for hypoparatyreoidisme; jf de Georges syndrom og automuun-polyendokrinopati-candidiasis-ectodermal dystrofi, pseudohypoparatyreoidisme EN hypoparathyroidism Kilde: Norsk medisinsk ordbok.)

Heart-burn cure may be worse than cause
seattletimes.nwsource.com 20.12.2005
CHICAGO — Holiday revelers beware: Seasonal indulgences such as 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 drugs for treating acid reflux — Prilosec, Prevacid and Nexium — seem more prone to getting a potentially dangerous diarrhea caused by the bacterium 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 at bay. (...)

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