Several additional articles have come to light regarding Proton Pump Inhibitors (PPIs). Proton Pump Inhibitors are medications like Prilosec (omeprazole), Protonix (pantoprazole), Nexium (esomeprazole), and others.
Shah (1) and colleagues found a slightly increased risk of heart attacks associated with patients having used PPIs. They went on to find that H2 blockers such as Pepcid (famotidine), Zantac (ranitidine), etc., which are less potent acid suppressors, were not associated with an increased cardiovascular risk.
Researchers from Washington University School of Medicine in St. Louis found a 25% increased risk of death in patients who took a PPI compared to those who took a less potent H2 blocker(2). Study author Dr. Ziyad Al-Aly reported that the longer a patient took the PPI, the higher the risk of death. However, criticisms of this study are quick to point out that the causes of death were not reported. The PPI group was apparently older and sicker, and therefore, the data should be interpreted with caution. It should also be noted that this was an observational study, which by definition can only show association, not causation.
Wang (3) and colleagues also found an association between PPI usage and strokes in a new study published in the American Journal of Gastroenterology. This risk was felt to be modest, and again, not necessarily causative.
However, it may not be all bad news for the PPI world. Goldstein (4) and colleagues from Emory University found that PPIs were not associated with a greater risk of dementia or of Alzheimer's disease as had been recently reported. This applied to those individuals at baseline with normal cognitive function or even those with mild cognitive impairment. This study involved over ten thousand individuals, and it applied to patients with both consistent and intermittent usage of PPIs. This study adjusted for bias in previous studies criticized for not having adequately controlled for issues such as alcohol usage and family history of dementia.
Where does that leave us with regard to the millions of PPI users in the world? Again, as had been suggested previously on this site, proton pump inhibitor medications have revolutionized the treatment of many gastrointestinal disease processes. Patient and health care provider must consider the risks and benefits of all therapies, and decide which is most appropriate. Please speak with your health care provider about what is right for you.
1. Shah NH, LePendu P, Bauer-Hehren A, Ghebremariam YT, Iyer SV, Marcus J, et al. (2015) Proton Pump Inhibitor Usage and the Risk of Myocardial Infarction in the General Population. PLoS ONE 10(6): e0124653. https://doi.org/10.1371/journal.pone.0124653.
2. http://www.msn.com/en-us/health/healthtrending/some-heartburn-drugs-linked-with-increased-risk-of-death. 7/11/2017.
3. Wang Y-F, Chen Y-T, Luo J-C, Chen T-J, Wu J-C, and Wang, S-J The American Journal of Gastroenterology 112, 1084-1093 (July 2017) | doi:10.1038/ajg.2017.101
4. Goldstein FC, Steenland K, Zhao L, Wharton W, Levey AI, Hajjar I. Proton Pump Inhibitors and Risk of Mild Cognitive Impairment and Dementia. Journal of the American Geriatrics Society. http://onlinelibrary. Wiley.com/doi/10.1111/jgs.1495/full.
As South Jersey's leading Gastroenterology practice, Jersey Shore Gastroenterology offers some of the best physicians in their field of practice. Again this year, Dr. Kenneth Schwab was recognized by South Jersey Magazine as a Top Doc of 2017. It is with great pride that we congratulate our colleague, Dr. Kenneth Schwab on this honor.
Pictured above left to right: Kim Malone, Dr. Kenneth Schwab, Melissa Bishop, Debbie Kennedy
On Sunday March 26, a team from Jersey Shore Gastroenterology participated in the Colon Cancer Coalition's Get Your Rear in Gear Event in Philadelphia to raise money for colon cancer education, screening, and prevention. While colon cancer takes many lives every year, it doesn't have to be that way. With early detection and regular screenings, colon cancer is preventable, treatable, and beatable. Jersey Shore Gastroenterology is proud to join in the Colon Cancer Coalition's efforts to raise awareness and provide everyone with the resources needed to both prevent and beat colon cancer.
There has been quite a bit of attention given to Proton Pump Inhibitor therapy, medications like Nexium, Prilosec, Omeprazole, Prevacid, etc., and side effects which may now include dementia and stroke. Keep in mind that some of these medications have been around for decades, and for the most part, they are extremely safe. They are typically used for Gastroesophageal Reflux Disease (GERD), ulcer disease, Barrett's esophagus, etc.
A recent article published in JAMA Neurology revealed that there may be a very weak association between the PPI's and dementia. This showed that of the patients studied with dementia, there was a higher likelihood of these patients having been on PPI's. However, this, by no means, proved causation. In addition, one of the criticisms of the article was that several critical factors were not controlled for including high blood pressure, family history of dementia, and alcohol usage. These factors are well known to be associated with the development of dementia.
The second issue is that of PPI therapy and stroke risk. This data comes from a Danish study presented at the American Heart Association 2016 Scientific Sessions. There is a suggestion that there may be a dose-related association between stroke risk and PPI therapy. Note that this has NOT yet been fully published, and therefore, we do not yet have all the details.
So, where does that leave us now? Again, for the most part, these medications have been around for decades, and are thought to be extremely safe. Therefore, one should not discontinue these medications or alter them without first discussing these issues with your health care provider. However, it is also not unreasonable to discuss with your health care provider whether you actually do need these medications. Do all patients with GERD need a PPI? Clearly, the answer is no. Many can get by with antacids or H2 Blockers (Pepcid, Zantac, etc.), or a lower dose of PPI's, possibly every other day or every third day dosing. My own opinion is that, at least in patients with Barrett's esophagus, where there is a higher risk of esophageal cancer, as well as those with erosive esophagitis due to severe GERD, the benefits to PPI therapy likely outweigh the risks.
Gomm W, von Holt K, Thomé F, et al. Association of proton pump inhibitors with risk of dementia: a pharmacoepidemiological claims data analysis. JAMA Neurol. 2015 Feb 15. [Epub ahead of print]
Sehested TS, Fosbol EL, Hansen PW, et al. Proton pump inhibitor use increases the associated risk of first-time ischemic stroke. A nationwide cohort study. Circulation. 2016; 134: A18462
March is colon cancer awareness month, and a great time to find out about colorectal cancer. Here are some of the most frequently asked questions. Ask your healthcare provider if you have additional questions.
WHAT IS COLORECTAL CANCER?
Colorectal cancer is cancer of the colon and rectum that begins with the development of pre-cancerous polyps from the lining of the colon and rectum.
WHAT IS A POLYP?
Polyps are mushroom-like growths that form when cells lining the colon grow, divide and reproduce in an unhealthy, disorderly way. Polyps can become cancerous over time, invading the colon wall and surrounding blood vessels, and spreading to other parts of the body.
WHAT CAUSES COLORECTAL CANCER?
The exact causes of colorectal cancer are unknown, but the disease appears to be caused by both inherited and lifestyle factors. Lifestyle factors - such as cigarette smoking, lack of physical exercise, and obesity - may increase the risk of developing the disease. Genetic factors may determine a person's susceptibility to the disease, whereas dietary and other lifestyle factors may determine which at-risk individuals actually go on to develop the disease. Most of the time no identifiable cause is found for the development of colorectal cancer in any given individual, and it is simply due to random genetic changes that have occurred in the cells lining the colon or rectum.
HOW COMMON IS COLORECTAL CANCER?
Colorectal cancer is the second leading cause of death from cancer in the United States, and the third most common cancer overall. This year, more than 56,000 Americans will die from colorectal cancer and more than 140,000 new cases will be diagnosed. In fact, more women over the age of 75 die from colorectal cancer than from breast cancer. Eighty to 90 million Americans (approximately 25 percent of the U.S. population) are considered at risk because of age or other factors. (American Cancer Society website)
WHO IS AT RISK FOR COLORECTAL CANCER?
Men and women ages 50 or older are at almost equal risk of developing colorectal cancer. Those who have a personal or family history of colorectal cancer or polyps are at higher risk of developing the disease. Anyone who has a long-term personal history of inflammatory bowel disease (Ulcerative Colitis or Crohn's Disease) also is at higher risk.
HOW CAN YOU PREVENT COLORECTAL CANCER?
See your doctor for yearly screenings if you are aged 50 or older. Be sure to maintain a diet low in animal fat and high in fruits, vegetables and fiber. Get regular exercise and avoid cigarette smoking. Keep alcohol consumption in moderation. Colon Cancer screening tests can identify and allow removal of pre-cancerous polyps and prevent the development of cancer.
Born in Edison, New Jersey, Dr. Jalaj earned a Bachelor of Science degree from New York Institute of Technology, and graduated summa cum laude. He attended SUNY Downstate College of medicine in Brooklyn, New York. Dr. Jalaj completed his residency in Internal Medicine at Boston University and his fellowship in gastroenterology at the University of Florida at Jacksonville. Dr. Jalaj went on to complete a subsequent advanced endoscopy fellowship at the University of North Carolina at Chapel Hill where he trained under the tutelage of renowned gastroenterologists, Drs. Todd Baron, Nicholas Shaheen, Lisa Gangarosa and Ian Grimm. This additional training makes Dr. Jalaj one of a select few physicians in southern New Jersey, and the only fellowship trained doctor in Atlantic County skilled in a variety of minimally invasive procedures including EUS (endoscopic ultrasound), ERCP with cholangioscopy and pancreatoscopy (direct visualization of the biliary tract and pancreatic duct, respectively), placement of stents in the gastrointestinal tract, single balloon enteroscopy (direct visualization of the small intestine), and removal of large gastrointestinal polyps. He is board certified in Gastroenterology and Internal Medicine.
Dr. Jalaj is on staff at AtlantiCare Regional Medical Center and Shore Medical Center. He is also a gastroenterology consultant at Bacharach Institute for Rehabilitation. Dr. Jalaj has two convenient offices in Somers Point and Egg Harbor Township. He is a member of several medical and gastroenterology societies including the American Society for Gastrointestinal Endoscopy and American Medical Association.
It is with great pride that we congratulate our colleague, Dr. Michael Krachman who was recognized by Healthy Living Magazine as a TOP DOC of 2015. NJ Top Docs reviews & approves NJ physicians from across the state of New Jersey and provides comprehensive profiles on these healthcare providers so you can find the best doctor in the state.
As South Jersey's leading Gastroenterology practice, Jersey Shore Gastroenterology offers some of the best physicians in their field of practice. Again this year, Dr. Kenneth Schwab was recognized by South Jersey Magazine as a Top Doc of 2015. It is with great pride that we congratulate our colleague, Dr. Kenneth Schwab on this honor.
As South Jersey's leading Gastroenterology practice, Jersey Shore Gastroenterology offers some of the best physicians in their field of practice. This year, one of our physicians was recognized by New Jersey Monthly Magazine as a TOP DOC of 2014. When local doctors were asked to vote for physicians they would choose to treat their own family members, this year's results included Dr. Krachman. It is with great pride that we congratulate our colleague, Dr. Joel Krachman on this honor.
As South Jersey's leading Gastroenterology practice, Jersey Shore Gastroenterology offers some of the best physicians in their field of practice. This year, one of our physicians was recognized by South Jersey Magazine as a Best Physician of 2013. After 19,000 votes were cast, from industry professionals to consumers, this years list was the biggest roundup ever for South Jersey Magazine. It is with great pride that we congratulate our collegue, Dr. Kenneth Schwab on this honor.
After months of preparation, dedication and hard work to prepare for this exciting day, Jersey Shore Gastro is delighted to officially announce the launch our newly designed website. The new site launched on September 10th, 2013, and is now available.
At JSG, our goal for the new website is to provide our visitors with an extremely user friendly website. This new innovative site will offer great functionality and easier navigation with lots of in-depth information about Jersey Shore Gastroenterology and its services.
There is much more information to read about, such as information about JSG, information about us and how JSG came to be, as well as services we offer. Under the Procedures section, we have given a substantial amount of detailed information about what we provide.
So, whether you are "just looking" or you are seeking more specific detail, or maybe seeking more information regarding gastroenterology, we are here to help you learn more as we strive to give the most updated information and offer great website experience for different types of guests that visit our site.