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    Wednesday, December 21, 2005

    Nature Bites Back: Are the little purple pill and its relatives responsible for the increasing incidence of C. diff colitis?

    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 germs at bay.

    The author works for the Purple Pill people, or at least she did. The results, however, are only expressed as odds ratios, which makes it difficult to assess the true significance of the findings based on the abstract.

    But, the increased in cases of C. diff colitis from 1994 to 2004 is striking - from 1 in 100,000 to 22 per 100,000. There's a graph in the paper which I wish I could reproduce for you that superimposes the number of prescriptions for proton pump inhibitors over those same years with the incidence rates of colitis. They have the same slope.

    The paper does provide more data than the abstract, too. Of those in the study who tested positive for C. diff colitis, 34% had tken antibiotics, and 24% had taken proton pump inhibitors (the purple pills), but only 7% had taken the older anti-acid/ulcer pills like Zantac or Tagamet. Interestingly, 38% had taken an arthritis medication like Motrin or Naprosyn and 20% had taken aspirin.

    Could it be that these drugs are so ubiquitous that they're used at that rate in the community and so it just seems like they're causing the colitis? That seems to be the case for aspirin, which was used at the same rate by the controls who did not have colitis, but not for the others. Only 8% of the non-colitis group used the purple pills, 4% used the older anti-ulcer medications (again, less of an absolute difference than the purple-pill users) and only 13% took antibiotics. There was a substantial difference in the arthritis drug use, too. Only 24% of the control group took arthritis drugs compared to 38% of colitis sufferers.

    Looks like there's something to the research. Maybe we should stop inhibiting so many proton pumps.

    posted by Sydney on 12/21/2005 08:50:00 AM 5 comments


    I can't wait to go back to the glorius days of bleeding ulcers! Is medpundit old enough to remember when gastric surgeries were some of the most common performed ?

    By Anonymous William Barrett MD, at 4:07 PM  

    No, I'm not that old, but there are a lot of people who take proton pump inhibitors who are not at risk for bleeding ulcers. They take them for indigestion. And quite a few take them so they can eat the stuff that causes the indigestion.

    By Blogger sydney, at 4:15 PM  


    I create new Health Blog Directory - http://alibaab.com
    Can you add your blog ?


    By Blogger Alibaab.com, at 5:34 PM  

    Since we can now test and treat for H Pylori, the incidence of bleeding ulcers may not be that high off the purple pills.
    I agree with Sydney. Too many patients take the meds so that they can continue eating and drinking without changing their lifestyle. Once had a patient who continued to drink 2-3 glasses of wine q HS and came to the VA seeking BID Nexium as rx'd by his private sector doc. I told him he needed to d/c the EtOH and that I could not get him the designer purple pill - only the generic.
    He claimed that he had never been told that EtOH was making his reflux worse. He was not happy with me and got his rx outside.

    By Anonymous Anonymous, at 5:37 PM  

    It is a well established "truth'" that the majority of individuals for whom the proton pump inhibitors et al, are prescribed do not have hyperchlorhydria, rather hypochlorhydria especially female and 40 and over. in fact back in '82' I tested saliva ph routinely (after W, Phillpot,M.D) and found hypochlorhydria common in twelve year olds. My theory being too many carbs (chips, cheezils etc)pre-meal.
    Also established; Helicobacter Pylori will not proliferate in an a alkaline medium, in other words pancreatic insufficiency (bicarbonates),leads to Helicobacter proliferation. One recalls also about "84" a Sydney (Australia) gastroenterologist claimed that it was not possible to have an ulcer in an alkaline medium.

    What bothers me as a clinical nutritionist is, and especially in the female, what happens to the Fe and Ca absorption in the absence of HCl? A well trained monkey could answer that question.
    So if you are ever interested in protocols that nurture and remedy the GI tract, give me a buzz.

    By Blogger Geoffrey, at 5:48 PM  

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