How Safe Are Popular Reflux Drugs?

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When stomach acid backs up all the way to the throat or even the nasal airway, it's called laryngopharyngeal reflux, according to the American Academy of Otolaryngology -- Head and Neck Surgery.

PPIs are widely prescribed for treating for both conditions.

In 2008, proton pump inhibitors were the third largest-selling therapeutic class in the United States, ringing up $13.9 billion in U.S. sales, according to IMS Health, a Norwalk, Conn.-based health-care data company. With 113.4 million prescriptions, they were the 6th most widely dispensed retail prescription medications, IMS reported.

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Of the various health problems being linked to PPIs, one of the most concerning involves its interaction with the blood thinner clopidogrel (Plavix). One study linked the drug combination to a 70 percent increased risk of heart attack or unstable angina and a 48 percent increased risk of stroke.

On that news, the Society of Cardiovascular Angiography and Interventions urged health-care providers treating patients with the clot-prevention therapy to consider prescribing antacids or other acid-blockers instead of PPIs. The U.S. Food and Drug Administration also recommended that health-care providers reevaluate PPI use in Plavix patients.

Yet there was no evidence from prospective randomized trials to support those cautionary statements, according to Johnson, who is also past president of the American College of Gastroenterology. "It was all retrospective, or subject to potential biases," he said.

Since then, three prospective studies, including papers published in The Lancet and data presented at a major cardiology meeting, have shown no adverse cardiac outcomes from the drug combination, Johnson noted.

Dr. Michael F. Vaezi, clinical director in the department of gastroenterology at Vanderbilt University Medical Center in Nashville, also believes the clinical importance of the associations reported in many of the PPI studies has been "overblown."

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