New research suggests that one out of every 200 patients being treated with gastric acid-suppressive drugs for heartburn and other conditions may develop pneumonia.
Researchers led by Chun-Sick Eom, MD, MPH, from Seoul National University Hospital in South Korea, conducted a review of studies published between 1985 and 2009, looking at the use of gastric acid-suppressive drugs and the risk of developing pneumonia.
Acid Suppressives Strongly Linked to Pneumonia
The researchers found a significant association between the use of one class of gastric acid suppressive, called proton pump inhibitors, and pneumonia. Eom and his colleagues also found a dose-response relationship between proton pump inhibitors and risk of pneumonia, meaning the more acid suppressive a patient took, the higher the risk of developing pneumonia. Examples of proton pump inhibitors include Aciphex, Nexium, Prevacid, Prilosec, Protonix, and Zegerid.
The researchers also found a strong association between the use of another class, histamine 2-receptor antagonists, and pneumonia. Examples of histamine 2 receptor antagonists include Axid, Pepcid, Tagamet, and Zantac.
The results are published in the Dec. 20 issue of the Canadian Medical Association Journal.
Forty percent to 70% of hospitalized patients receive acid suppressive medication. The researchers say frequent use of these drugs may be contributing to hospital-acquired pneumonia illnesses and deaths. The findings suggest that doctors should exercise caution when prescribing these acid suppressives, particularly among patients at high risk for developing pneumonia.
Biological Explanations
There may be several reasons as to why acid suppressives may have this association with pneumonia, Eom and his team report. Acid-suppressive drugs may increase the risk for pneumonia by blocking gastric acid, which could lead to bacteria overgrowth in the upper gastrointestinal tract that may travel to the lungs. It's also possible the acid-suppressive medication inhibits immune cells, reducing their ability to fight off bacteria and infection.
Acid-suppressive drugs are the second most commonly sold and used medication worldwide, totaling more than $26 billion in sales in 2005 in the U.S. They are prescribed to treat conditions such as heartburn, gastroesophageal reflux disease, and ulcers. Previous studies have examined a possible link between these drugs and pneumonia in the past, but the results have been mixed.
"Several previous studies have shown that treatment with acid-suppressive drugs might be associated with an increased risk of respiratory tract infections and community-acquired pneumonia in adults and children,” Eom and his colleagues wrote. "Given the widespread use of proton pump inhibitors and histamine 2-receptor antagonists, clarifying the potential impact of acid-suppressive therapy on the risk of pneumonia is of great importance to public health."
Will Eating This Give Me Heartburn?
Good question -- and the answer might not be what you expect. First, here are a few basic facts about heartburn, which has nothing to do with the heart. Heartburn happens when stomach acid refluxes, or seeps, through a valve called the lower esopahgeal sphincter and irritates the esophagus. Certain foods can trigger heartburn, but you may have a little more food freedom than you think, if you consider the pointers in this slideshow.
Heartburn Trigger: Too Much Food
The first thing to think about, in terms of curbing heartburn, isn't this or that specific food. It's the amount of food you eat at a time. When it comes to heartburn risk, the sheer volume of what you eat matters. And this is one case where bigger isn't better. No matter what the food is, how good it looks, or how much you like it, eating too much food at once makes heartburn more likely. Tip: Try using smaller plates to trim your portions.
Heartburn Trigger: Eating on the Go
Always eating in a hurry? Shoveling food down is also a no-no, if you want to tame heartburn. Leslie Bonci, MPH, RD, CSSD, director of sports nutrition at the University of Pittsburgh Medical Center, says the three G's -- grab, gulp, and go -- don't make for good digestion and can make GERD (gastroesophageal reflux disease) symptoms more likely. Heartburn is a GERD symptom. So slow down when you eat if you're concerned about heartburn symptoms.
Heartburn Trigger: Fatty Foods
High-fat foods tend to stay in the stomach longer, and the longer they're there, the more likely discomfort can be, note Bonci and Elaine Magee, MPH, RD, author of Tell Me What to Eat If I Have Acid Reflux. And if you're eating big servings of those high-fat foods -- like a lot of fried chicken, chips, or wings -- then you've got a double whammy of two potential heartburn triggers -- too much food and fatty fare.
Heartburn Tip: Cut Back on Fat
You may not have to give up your favorite foods. Preparing them differently could help tame your heartburn. You might be able to bake, broil, grill, or roast some foods instead of frying them. And you could trim extra fat off meat and poultry, and cut the skin off chicken. Little tweaks might trim enough fat to make a difference for heartburn – and your overall health.
Heartburn Trigger: Acidic Foods
Acidic foods -- which include tomatoes and products that contain tomatoes (such as tomato sauce and salsa) and citrus fruits (such as oranges, grapefruits, and lemons) -- can trigger heartburn, especially if you eat them by themselves, on an empty stomach. Vinegar is also highly acidic -- not that you're going to eat vinegar by itself, but it's a common ingredient in salad dressings and other dishes.
Heartburn Tip: Limit Acidic Foods
You've got lots of other options for fresh produce besides tomatoes and citrus fruits. Try choosing some other fruits and vegetables. If you do want to have acidic foods, limit the portion size and have something else -- that isn't acidic -- with it. For instance, have a little less tomato sauce and have it with spaghetti and a little meat or vegetables at the same time. Everyone is different, so experiment to find your comfort zone.
Drinks That May Trigger Heartburn
Preventing heartburn isn't just about food choices. Certain drinks can make heartburn more likely, inlcluding coffee (regular or decaffeinated), caffeinated tea, colas, carbonated drinks, and excess alcoholic beverages. Caffeinated beverages boost acid in the stomach and alcoholic beverages can relax the lower esophageal sphincter, leading to heartburn. And sodas, regardless of caffeine, can bloat the stomach, which may lead to heartburn.
Heartburn Tip: Try Other Drinks
To make heartburn less likely, choose drinks that aren't fizzy and don't contain caffeine. Options include herbal teas, milk, and plain water. Having water with meals would also dilute stomach acid, making heartburn less likely. You may also want to limit tomato or citrus juices because of their acidity. And if you must have your coffee or other drinks that could promote heartburn, try to cut back -- maybe a smaller mug would help.
Heartburn Trigger: Chocolate
Chocolate contains caffeine, and caffeine can be a heartburn trigger. But if you can't bear the thought of giving up chocolate, see if cutting back helps you avoid heartburn. Watch your portion size, too; maybe you can handle a nibble. And keep the big picture in mind -- is that chocolate coming at the end of a fatty feast? Are you eating it by itself on an empty stomach? In short, what other heartburn triggers may be at play?
Heartburn Trigger: Spicy Foods
Got a taste for spicy foods -- the hotter, the better? All that heat may provoke heartburn. Peppery foods and hot sauces can be heartburn triggers. But it's not just scorching hot items that are in question. Peppermint is cool, not fiery, but it may relax the lower esophageal sphincter, leading to heartburn. And although garlic and onions aren't spices, they are flavorful foods that may spur heartburn.
Heartburn Tip: Hold the Heat
Just because you have heartburn, you aren't necessarily headed for a lifetime of bland foods. Try turning down the heat. You don't have to drown your wings in hot sauce, for instance. And maybe you could dial your chili down to two alarms instead of four. Easing up a bit on the spiciness could make a difference. "There are other ways to flavor foods that don't really require something that burns one's tongue," says Bonci.
Heartburn Tip: Write It Down
Everyone's different. Your heartburn triggers might be different from someone else's. For instance, you might tolerate spicy foods better than someone else with heartburn, and you might find you can handle a small cup of coffee as long as you don't gulp it down by itself. You'll want to learn what you can handle and what leads to heartburn, and jotting that down can help you pinpoint what eating habits you need to change.
Heartburn Tip: Try Chewing Gum
Magee suggests chewing gum after a meal to stimulate saliva production, since saliva neutralizes acid and spurs the stomach to move its contents into the small intestine faster -- basically, moving it down the line before heartburn sets in. Magee recommends picking a flavor that isn't peppermint or mint, in order to avoid relaxing the lower esophageal sphincter.
More Heartburn Tips
Want more ways to curb heartburn? Don't lie down right after a meal -- allow three hours between dinner and bedtime. Since smoking and being overweight may also make heartburn more likely, take steps toward a healthier lifestyle, if warranted. And although occasional heartburn is common, you may want to ask your doctor about frequent heartburn, which could be a symptom of GERD.
SOURCE:rxlist.com
Researchers led by Chun-Sick Eom, MD, MPH, from Seoul National University Hospital in South Korea, conducted a review of studies published between 1985 and 2009, looking at the use of gastric acid-suppressive drugs and the risk of developing pneumonia.
Acid Suppressives Strongly Linked to Pneumonia
The researchers found a significant association between the use of one class of gastric acid suppressive, called proton pump inhibitors, and pneumonia. Eom and his colleagues also found a dose-response relationship between proton pump inhibitors and risk of pneumonia, meaning the more acid suppressive a patient took, the higher the risk of developing pneumonia. Examples of proton pump inhibitors include Aciphex, Nexium, Prevacid, Prilosec, Protonix, and Zegerid.
The researchers also found a strong association between the use of another class, histamine 2-receptor antagonists, and pneumonia. Examples of histamine 2 receptor antagonists include Axid, Pepcid, Tagamet, and Zantac.
The results are published in the Dec. 20 issue of the Canadian Medical Association Journal.
Forty percent to 70% of hospitalized patients receive acid suppressive medication. The researchers say frequent use of these drugs may be contributing to hospital-acquired pneumonia illnesses and deaths. The findings suggest that doctors should exercise caution when prescribing these acid suppressives, particularly among patients at high risk for developing pneumonia.
Biological Explanations
There may be several reasons as to why acid suppressives may have this association with pneumonia, Eom and his team report. Acid-suppressive drugs may increase the risk for pneumonia by blocking gastric acid, which could lead to bacteria overgrowth in the upper gastrointestinal tract that may travel to the lungs. It's also possible the acid-suppressive medication inhibits immune cells, reducing their ability to fight off bacteria and infection.
Acid-suppressive drugs are the second most commonly sold and used medication worldwide, totaling more than $26 billion in sales in 2005 in the U.S. They are prescribed to treat conditions such as heartburn, gastroesophageal reflux disease, and ulcers. Previous studies have examined a possible link between these drugs and pneumonia in the past, but the results have been mixed.
"Several previous studies have shown that treatment with acid-suppressive drugs might be associated with an increased risk of respiratory tract infections and community-acquired pneumonia in adults and children,” Eom and his colleagues wrote. "Given the widespread use of proton pump inhibitors and histamine 2-receptor antagonists, clarifying the potential impact of acid-suppressive therapy on the risk of pneumonia is of great importance to public health."
Will Eating This Give Me Heartburn?
Good question -- and the answer might not be what you expect. First, here are a few basic facts about heartburn, which has nothing to do with the heart. Heartburn happens when stomach acid refluxes, or seeps, through a valve called the lower esopahgeal sphincter and irritates the esophagus. Certain foods can trigger heartburn, but you may have a little more food freedom than you think, if you consider the pointers in this slideshow.
Heartburn Trigger: Too Much Food
The first thing to think about, in terms of curbing heartburn, isn't this or that specific food. It's the amount of food you eat at a time. When it comes to heartburn risk, the sheer volume of what you eat matters. And this is one case where bigger isn't better. No matter what the food is, how good it looks, or how much you like it, eating too much food at once makes heartburn more likely. Tip: Try using smaller plates to trim your portions.
Heartburn Trigger: Eating on the Go
Always eating in a hurry? Shoveling food down is also a no-no, if you want to tame heartburn. Leslie Bonci, MPH, RD, CSSD, director of sports nutrition at the University of Pittsburgh Medical Center, says the three G's -- grab, gulp, and go -- don't make for good digestion and can make GERD (gastroesophageal reflux disease) symptoms more likely. Heartburn is a GERD symptom. So slow down when you eat if you're concerned about heartburn symptoms.
Heartburn Trigger: Fatty Foods
High-fat foods tend to stay in the stomach longer, and the longer they're there, the more likely discomfort can be, note Bonci and Elaine Magee, MPH, RD, author of Tell Me What to Eat If I Have Acid Reflux. And if you're eating big servings of those high-fat foods -- like a lot of fried chicken, chips, or wings -- then you've got a double whammy of two potential heartburn triggers -- too much food and fatty fare.
Heartburn Tip: Cut Back on Fat
You may not have to give up your favorite foods. Preparing them differently could help tame your heartburn. You might be able to bake, broil, grill, or roast some foods instead of frying them. And you could trim extra fat off meat and poultry, and cut the skin off chicken. Little tweaks might trim enough fat to make a difference for heartburn – and your overall health.
Heartburn Trigger: Acidic Foods
Acidic foods -- which include tomatoes and products that contain tomatoes (such as tomato sauce and salsa) and citrus fruits (such as oranges, grapefruits, and lemons) -- can trigger heartburn, especially if you eat them by themselves, on an empty stomach. Vinegar is also highly acidic -- not that you're going to eat vinegar by itself, but it's a common ingredient in salad dressings and other dishes.
Heartburn Tip: Limit Acidic Foods
You've got lots of other options for fresh produce besides tomatoes and citrus fruits. Try choosing some other fruits and vegetables. If you do want to have acidic foods, limit the portion size and have something else -- that isn't acidic -- with it. For instance, have a little less tomato sauce and have it with spaghetti and a little meat or vegetables at the same time. Everyone is different, so experiment to find your comfort zone.
Drinks That May Trigger Heartburn
Preventing heartburn isn't just about food choices. Certain drinks can make heartburn more likely, inlcluding coffee (regular or decaffeinated), caffeinated tea, colas, carbonated drinks, and excess alcoholic beverages. Caffeinated beverages boost acid in the stomach and alcoholic beverages can relax the lower esophageal sphincter, leading to heartburn. And sodas, regardless of caffeine, can bloat the stomach, which may lead to heartburn.
Heartburn Tip: Try Other Drinks
To make heartburn less likely, choose drinks that aren't fizzy and don't contain caffeine. Options include herbal teas, milk, and plain water. Having water with meals would also dilute stomach acid, making heartburn less likely. You may also want to limit tomato or citrus juices because of their acidity. And if you must have your coffee or other drinks that could promote heartburn, try to cut back -- maybe a smaller mug would help.
Heartburn Trigger: Chocolate
Chocolate contains caffeine, and caffeine can be a heartburn trigger. But if you can't bear the thought of giving up chocolate, see if cutting back helps you avoid heartburn. Watch your portion size, too; maybe you can handle a nibble. And keep the big picture in mind -- is that chocolate coming at the end of a fatty feast? Are you eating it by itself on an empty stomach? In short, what other heartburn triggers may be at play?
Heartburn Trigger: Spicy Foods
Got a taste for spicy foods -- the hotter, the better? All that heat may provoke heartburn. Peppery foods and hot sauces can be heartburn triggers. But it's not just scorching hot items that are in question. Peppermint is cool, not fiery, but it may relax the lower esophageal sphincter, leading to heartburn. And although garlic and onions aren't spices, they are flavorful foods that may spur heartburn.
Heartburn Tip: Hold the Heat
Just because you have heartburn, you aren't necessarily headed for a lifetime of bland foods. Try turning down the heat. You don't have to drown your wings in hot sauce, for instance. And maybe you could dial your chili down to two alarms instead of four. Easing up a bit on the spiciness could make a difference. "There are other ways to flavor foods that don't really require something that burns one's tongue," says Bonci.
Heartburn Tip: Write It Down
Everyone's different. Your heartburn triggers might be different from someone else's. For instance, you might tolerate spicy foods better than someone else with heartburn, and you might find you can handle a small cup of coffee as long as you don't gulp it down by itself. You'll want to learn what you can handle and what leads to heartburn, and jotting that down can help you pinpoint what eating habits you need to change.
Heartburn Tip: Try Chewing Gum
Magee suggests chewing gum after a meal to stimulate saliva production, since saliva neutralizes acid and spurs the stomach to move its contents into the small intestine faster -- basically, moving it down the line before heartburn sets in. Magee recommends picking a flavor that isn't peppermint or mint, in order to avoid relaxing the lower esophageal sphincter.
More Heartburn Tips
Want more ways to curb heartburn? Don't lie down right after a meal -- allow three hours between dinner and bedtime. Since smoking and being overweight may also make heartburn more likely, take steps toward a healthier lifestyle, if warranted. And although occasional heartburn is common, you may want to ask your doctor about frequent heartburn, which could be a symptom of GERD.
SOURCE:rxlist.com
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