 Whether you've been diagnosed with a peptic ulcer, gastroesophageal reflux disease (GERD) or just have some annoying heartburn from time to time, the odds are your doctor or pharmacist has pushed you towards drugs like Prevacid, Prilosec and Nexium. All are a variety of proton pump inhibitors (PPIs), the most potent inhibitors of stomach acid secretion currently on the market as both prescription and non-presciption drugs. But evidence is mounting that these medications can lead to some troublesome and even serious side effects. In fact, a new study just published in the Journal of the American Medical Association (JAMA) concludes that by disrupting the body's natural balance, PPIs may cause deadly pneumonia. Pis are now among the most widely-selling drugs in the world and are frequently given to hospitalized patients to prevent or treat heartburn. Background information in the JAMA article estimates between 40 percent and 70 percent of hospitalized patients receive some form of these drugs -- even though the medications are often used for indications not supported by data and research. And now comes a study headed by Shoshana J. Herzig, M.D., of Beth Israel Deaconess Medical Center in Boston showing this practice appears to be downright dangerous. The reason? Hospitalized patients given acid-suppressive medications have a hugely increased risk of developing pneumonia while in the hospital. Dr. Herzig and colleagues studied data on patients who were admitted to a large, urban, academic medical center between January 2004 and December 2007. These were patients who were at least 18 years of age, hospitalized for three or more days, and not so sick they had to be admitted to the intensive care unit. Acid-suppressive medication use was defined as any order for a proton-pump inhibitor or another acid blocking type of drug known as a histamine2 receptor antagonist (used less frequently than PPIs). In all, the researchers investigated data on 63,878 hospital admissions and found that 52 percent were given acid-suppressing medication. The majority, almost 90 percent, were placed on these drugs within 48 hours of being admitted to the hospital. Of the group who received these medications, 27,236 (83 percent) received PPIs and 7,548 (23 percent) received histamine2 receptor antagonists. Some were actually given both kinds of stomach acid fighting drugs. The scientists at first documented that 2,219 of the patients (3.5 percent) developed hospital-acquired pneumonia and this risk was far higher in the group exposed to acid-suppressive medication relative to the unexposed group (almost five percent compared to two percent). But after the researchers conducted further analysis and adjusted for potential factors that could influence the outcomes, they concluded that receiving acid-suppressive medications was associated with a dramatic 30 percent increase in the odds of coming down with hospital-acquired pneumonia. There was no similar increase in the patients who only received the histamine2 receptor antagonists. So how could drugs that supposedly control acid production in the stomach have anything to do with germs infecting the lungs? The researchers join other scientists who have raised an alarm that these acid-suppressive medications cause changes in the body's natural balance of micro flora (the balance between the 'good' and potentially 'bad' bacteria that live inside all of us). Specifically, PPIs may well increase the risk of pneumonia because they modify upper gastrointestinal bacteria, and, in turn, modify respiratory bacteria. The result can be that disease-causing bacteria are not kept under control and pneumonia develops. 'These results occur in the context of an increasing body of literature suggesting an association between acid-suppressive medication and pneumonia. Further scrutiny is warranted regarding inpatient prescribing practices of these medications,' the study authors concluded in a statement to the media. Other dangers of PPI drugs A host of other health problems have been linked to PPIs recently. The University of Maryland Medical Center web site notes that long-term use of high-dose PPIs may produce vitamin B12 deficiencies and that these drugs have also been linked to an increased risk of hip fractures. In fact, as covered earlier this year in selfnews ( http://www.selfnews.com/025369.html ), taking PPIs for five years or more has been correlated with a 62 percent increase in the risk of osteoporosis-related hip fractures, while use for seven years or more has been correlated with a risk increase of more than 400 percent. More bad news about PPIs: research presented at the annual meeting of the Society for Cardiovascular Angiography and Intervention earlier this month concluded that taking drugs like Nexium, Prevacid, Prilosec and Protonix can be dangerous for heart patients who are also taking anti-clotting medications. PPIs were found to boost the risk of heart attack and stroke in these people by 50 percent. Fortunately, many natural alternatives are available to help with heartburn, GERD and even ulcers. A recent selfnews article ( http://www.selfnews.com/026245.html ) reported, for example, on research published in the World Journal of Gastroenterology that indicates an herb long used in Mediterranean cuisine known as Eruca sativa (also called rocket or arugula) could be a safe alternative to PPIs. Reference: JAMA. 2009;301[20]:2120-2128. For more information: http://www.mayoclinic.com/health/proton-pump... http://www.sciencedaily.com/releases/2009/01... http://latimesblogs.latimes.com/booster_shot... http://www.theheart.org/article/967075.do http://www.ncbi.nlm.nih.gov/pubmed/19149516 http://www.umm.edu/patiented/articles/what_d... 