Beware the Long-Term Use of Drugs for Gastrointestinal Problems

Heartburn is one of the most common gastrointestinal disorders and, apparently, a problem that leads too often to overprescribing drugs. That’s the conclusion of a study in the Journal of Internal Medicine by researchers from Northwestern University.

As summarized on, doctors often write prescriptions for proton pump inhibitors (PPIs) at excessive doses. And they often advise patients to take the medicine for too long. The risks of such overuse are bone fractures, infections and pneumonia.

Such drugs include Nexium, Prilosec, Prevacid and Protonix.

In addition to the generic problem known as “heartburn” or acid reflux (burning in the chest, neck or throat caused by stomach acid moving up into the esophagus), PPIs are prescribed for gastroesophageal reflux disease (GERD), stomach and intestinal ulcers and inflammation of the esophagus. The medicine reduces the amount of acid in the stomach.

The researchers said appropriate prescriptions are the lowest effective dose for four to eight weeks. If the symptoms aren’t relieved by then, doctors are supposed to seek other causes for the problem and investigate different types of treatments. But, too often, that’s not what happens.

Of 1,600 veterans diagnosed with GERD at a Veterans Affairs Hospital, the study showed that about 373 were prescribed high doses from the start and were kept on the pills for 90 days or longer. More than 8 in 10 patients received at least one refill, and many took the drug for more than two years.

As noted on AboutLawsuits, in 2010 and again in 2011 the FDA compelled manufacturers of proton pump inhibitors to update their warning labels to include information about the risks associated with use of the medications. (See our blog, “New Safety Concerns Over Celexa, Proton Pump Inhibitors.”) Nexium is the most popular drug in this class, and generates more than $6 billion in annual sales.

Over-the-counter versions of PPIs do not appear to pose the same risks.

Several former patients who suffered bone fractures, says AboutLawsuits, are suing AstraZeneca, the manufacturer of Nexium, claiming that the company did not sufficiently warn consumers about the risks associated with long term use.

If you have gastrointestinal pain, Choosing Wisely, an initiative of the American Board of Internal Medicine (ABIM) Foundation, recommends that before using a prescription PPI you try other treatments Choosing Wisely says that as many as 7 in 10 people taking a PPI were never diagnosed with GERD, that, instead, they might have less serious heartburn. That often can be eased with dietary and other lifestyle changes and, if necessary, antacids like Rolaids and Tums.

If your doctor prescribes a PPI for acid reflux or any other disorder, ask if the dose is the lowest possible for your symptoms. Don’t take it for longer than six weeks. If your symptoms haven’t resolved, discuss with your doctor if there might be another reason besides the one diagnosed for the symptoms, and whether other treatment options are available. If you take any of these drugs and have an adverse response, file a report with the FDA’s MedWatch program.

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