Be cautious about long-term proton pump inhibitor use

Ask Dr. Keith Roach M.D

Be cautious about long-term proton pump inhibitor use

DEAR DR. ROACH: Like thousands of people, I have experienced heartburn for years. Chewable antacid tablets provide temporary relief. Extended use of ranitidine and famotidine gave me partial relief, but I still required regular use of antacid tablets. But starting omeprazole gave me immediate and complete relief. I'm sure results are different for different people. The package for omeprazole says 'three 14-day courses of treatment.' My question is, can omeprazole be safely taken long-term? — Anon.

ANSWER: Omeprazole (Prilosec and others) is a proton pump inhibitor, which prevents the stomach from making acid. This class of drugs is very effective for many people with symptoms of acid reflux, or GERD.

There are two reasons to be cautious about long-term use. The first is that, like all medicines, PPIs have side effects. Among the side effects are an increase in the risk of bacterial pneumonia, increased likelihood of osteoporosis and possible adverse effects on the kidney.

The second reason is that the same symptoms attributed to GERD might be something more serious, such as ulcers or stomach cancer. Guidelines by gastroenterological societies recommend a careful evaluation in those who require long-term treatment, and I absolutely agree.

My experience is that many people take these drugs longterm, even if they didn't have long-term symptoms when they started. Many patients can come off these medications and can be treated with lifestyle changes or sometimes with occasional use of medications like ranitidine (Zantac) or famotidine (Pepcid). These are antihistamines specific for the stomach that partially block acid secretion. However, for those who continue to have significant symptoms despite other treatments and who have had a thorough evaluation to rule out serious problems, long-term use is reasonable.

DEAR DR. ROACH: A pet peeve: Why do almost all doctor's and dentist's offices have TVs going ALL THE TIME? Often blaring. It is NOT for the patients' benefit! Look around, as I have done dozens and dozens of times, and count the number of people actually watching. If there are 20 people waiting in a group area, perhaps one will be watching the TV, while everyone else is trying to read or is paying attention to his mobile device.

TV can be very upsetting — the opposite of what a waiting patient needs.

In any office where SERIOUS procedures are underway (chemo/radiation), you will not find emotionally upsetting, trivial and loud TV! What do you think of this practice? — C.C.

ANSWER: I agree with you completely. I don't enjoy televisions in doctors' waiting rooms. They often are too loud, and advertisements for pharmaceuticals may have the appearance of being condoned by the medical office. Medical shows, especially those promoting or exploring controversial practices, also are potentially problematic to show in a physician's office. I am sure medical professionals put them there for the enjoyment of their patients, but I don't like them at all. Also, in a well-run practice, people often shouldn't be waiting so long that they are getting bored.

That being said, I don't think they are unethical or unprofessional. I'd be curious to hear other points of view. *** Dr. Roach regrets that he is unable to answer individual letters, but will incorporate them in the column whenever possible. Readers may email questions to ToYourGoodHealth@med.cornell. edu or request an order form of available health newsletters at 628 Virginia Dr., Orlando, FL 32803. Health newsletters may be ordered from www.rbmamall.com.