Heart-burn cure may be worse than cause

CHICAGO — Holiday revelers beware: Seasonal indulgences such as eggnog and fruitcake might give you heartburn, but the acid-fighting medicine you take for relief might lead to something worse, researchers say.

People on popular prescription drugs for treating acid reflux — Prilosec, Prevacid and Nexium — seem more prone to getting a potentially dangerous diarrhea caused by the bacterium Clostridium difficile, new research shows. C-diff, as it's known, can cause severe diarrhea and crampy intestinal inflammation called colitis.

Dr. Sandra Dial and colleagues at McGill University in Montreal examined data on more than 18,000 patients in the United Kingdom from 1994 to 2004. During that time, 1,672 cases of C-diff were diagnosed, and the numbers increased from less than 1 per 100,000 in 1994 to 22 per 100,000 last year.

Patients with prescriptions for powerful acid fighters called proton pump inhibitors, which include Prilosec and Prevacid, were almost three times more likely to be diagnosed with the bug than those not taking the drugs.

Those on less potent prescription drugs called H2 receptor antagonists, which include Pepcid and Zantac, were two times more likely than nonusers to get C-diff infections.

The widely used and heavily promoted drugs reduce levels of gastric acid that can keep C-diff at bay.

Dr. L. Clifford McDonald, a researcher at the federal Centers for Disease Control and Prevention, said proton pump inhibitors recently were implicated in a C-diff outbreak in Maine.

"It's not surprising in my mind that there could be some association" with acid-fighting drugs, said McDonald.

Most study patients hadn't been recently hospitalized and weren't taking antibiotics, both risk factors for C-difficile infections. The study will appear in Wednesday's Journal of the American Medical Association.

A co-author is a consultant for AstraZeneca, which markets Prilosec and Nexium, and Altana Pharma, which makes and markets another prescription heartburn drug, Protonix, in Europe.

A spokesman for Wyeth, which markets Protonix in the United States, said the company hadn't seen the research and declined to comment.

AstraZeneca spokeswoman Cindy Callaghan said, "Further research is needed ... to determine the validity of a potential link."

Dr. Michael Brown, a gastroenterologist at Rush University Medical Center in Chicago, who was not involved in the study, said short-term use of potent acid-fighting drugs is unlikely to increase infection risks in otherwise healthy people. But he said the study results suggest doctors and patients "have to think twice about using such heavy acid suppression" over the long term.