Bad Effects of Gastric Acid Lowering Drugs in Long Term Use

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Gastric acid lowering drugs dramatically improved the treatment options of acid peptic diseases. Once the primary treatment, surgery has become perhaps the second or third option in acid peptic disease management. There are two main groups of these drugs;

• Histamine II blockers;
1. Cimetidine,
2. Ranitidine,
and
3. Famotidine
etc.and
• Proton pump inhibitors (PPI);
1. Omeprazole,
2. esomeprazole,
3. Lansoprazole,
4. Rabeprazole,
and
5. Pantoprazole

etc. Now FDA has certain reservations to make the PPI drugs available over the counter (OTC).
Main adverse effect of cimetidine was gynaecimastia and it not much in use.
PPIs were first blamed for development of benign stomach tumors, but subsequently cleared from it. Now, researchers indicate these for;

1. Osteopenia; related to the decreased calcium absorption due to gastric acid lowering, hampered calcium ionization and absorption from the gut.
2. Decreasing the full potential of tamoxifen action on breast cancer by sharing its the metabolic pathway in the liver; resulting in more recurrence rate of breast cancer.
3. Decreasing the blood thinning effect of clopidogrel when used along with aspirin as a gastro-protector and thereby increasing the return of heart patients to emergency department with increased cardiovascular events.
4. Continuous use of it is also linked to increased colonization of harmful bacteria in the gut, and specially C. difficile, known to cause colitis and loose motion.
5. These drugs by  virtue of strong acid lowering property often suppress the symptoms of gastric cancer resulting in loss of golden hours and time in subjecting a patient to endoscopy for diagnosis of cancer. These patients, especially in India come very late when PPIs no more improve the symptoms or secondary effects of cancer appear
These are good drugs having very good utility, but patients by virtue of dependency and ignorance are overusing PPIs and further, over the counter (OTC) availability will definitely increase their misuse, ultimately landing to more problems. Always, judicious use of a good armor in the hands of physicians will yield very good results.  

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