DEAR DR. DONOHUE: Will you please comment on the effects of long-term Prevacid for GERD? A friend has had this for 10 years and has taken Prevacid for many years. I went on the Internet and found this statement about Prevacid: "This product should never be taken for more than 14 days and not longer than four months. Long-term use could result in pre-cancerous nodules in the esophagus, stomach and colon." My friend is now receiving chemotherapy and radiation for cancer of the esophagus and stomach.
I have never seen mention of this in your column. — Anon.
ANSWER: GERD — gastroesophageal reflux disease, heartburn — is one of humankind's most common disorders. It's the spurting upward of stomach acid and digestive juices into the esophagus, the swallowing tube. Prevacid belongs to a class of medicines called proton pump inhibitors. It effectively stops the production of stomach acid, and for most it quickly relieves the pain of heartburn. The other PPI drugs are: Dexilant, Nexium, Prilosec, Protonix and Aciphex.
If it's possible, limiting the time during which PPIs are used is desirable. However, heartburn is a chronic condition, and chronic administration of drugs is essential for containing it. Doctors, therefore, have latitude in the length of treatment.
Prolonged used of PPIs encourage the growth of a digestive tract bacterium called C. difficile. It can give rise to diarrhea and is sometimes difficult to uproot.
Prolonged use has been associated with an increased risk for breaking bones, especially the hip bone. However, reliable data on this issue are conflicting. The Food and Drug Administration has not required that any warning about bone breaks be issued.
The threat of cancers of the digestive tract was once believed to be possible. Further research has not substantiated this threat.
People ought to get off PPIs from time to time to see if they truly need long-term treatment. They can use other medicines, like Maalox, Tums or Rolaids. Avoiding foods that stimulate acid production is another worthwhile treatment. Those foods include chocolate, peppermint, spicy food, citrus fruit, tomatoes, alcohol and caffeine. Elevating the head of the bed with 6-inch blocks under the bedposts is helpful.
The booklet on heartburn explains this common disorder. Readers can obtain a copy by writing: Dr. Donohue — No. 501, Box 536475, Orlando, FL 32853-6475. Enclose a check or money order (no cash) for $4.75 U.S./$6 Can. with the recipient's printed name and address. Please allow four weeks for delivery.
DEAR DR. DONOHUE: I've been told that raw milk and bone broth is a good treatment for osteoporosis. Will you comment on this? — P.
ANSWER: Bone broth, made by cooking bones in boiling water, is a source of calcium. It's a reasonable way to meet one's calcium requirement. I can't find a reference that gives the exact calcium content. It depends on how many bones are used. Raw milk is another source of calcium. "Raw" means not pasteurized. Since milk has been pasteurized, the number of infections that came from drinking unpasteurized milk has plummeted. I can't endorse using raw milk.
DEAR DR. DONOHUE: I am 79 and dread the annual Pap test. Is it really necessary for me to continue it? — D.M.
ANSWER: If a woman is 65 or older and has had three normal consecutive Pap smears, she can stop having the test.
Talk to your doctor about this. The doctor might have reasons for continuing the test that aren't known by you or me.
Dr. Donohue regrets that he is unable to answer individual letters, but he will incorporate them in his column whenever possible. Readers may write him or request an order form of available health newsletters at P.O. Box 536475, Orlando, FL 32853-6475. Readers may also order health newsletters from www.rbmamall.com.