Acid Reducers and C Diff - which ones are safe?

[BonSong]

From my research there seems to be some controversy about acid reducing medications causing someone to be prone to c. diff or relapse, as they alter the acidic environment in the stomach so that may alter gut flora (i.e., the beneficial gut flora that keep c. diff at bay).

So far I've heard that it is Proton Pump Inhibitors (PPIs) that have this effect the most. But H2 receptor antagonists, such as Zantac, Tagamet, etc. is still of some controversy.

I've been struggling - bad - with GERD. I almost didn't give a crap and broke down and took some Zantac today, but I held back. Just so afraid of c. diff relapse. It seems even doctors have differing opinions on this, but I'm sure it's been studied at least a bit more? Does anyone have any updated resources on this? I'll share here if I find anything new or recent~ this is the most recent I could find, and it is a scientific paper, incredibly technical and difficult to follow even if you are pretty up on medical jargon. http://www.plosone.org/article/info%3Ad ... ne.0056498 and all that lingo to just conclude: "In this rigorous systematic review and meta-analysis, we observed an association between H2RAs and CDI. The absolute risk of CDI associated with H2RAs was highest in hospitalized patients receiving antibiotics. On the other hand, our findings are re-assuring that H2RAs use in the general population as over-the-counter medications do not pose a significant CDI risk."

Wish it would state the reasons why.

[beth22]

Allison just posted the link to an article in media reports the other day on this topic. Check it out.

[AllisS]

The evidence for a link between C. difficile and long-term PPI use has been accumulating. I'd been on PPIs in excess of 15 years at the time that I got C. difficile, which may have predisposed me to it. I stopped taking PPIs within the last year; now, I seldom get GERD that feels severe enough to require Zantac or a similar drug. In fact, chewing gum often resolves my GERD, though sugarless gum may contain sorbitol or mannitol, which can cause IBS-like symptoms.

If you take Zantac only as needed -- or even a PPI just as needed (doctors now prescribe it for continuous use, but I've read there's now disagreement as to the need for it to be continuous in order to get a benefit) -- I'd think your risk would be much lower. That said, severe GERD, especially if you've had a finding of erosive esophagitis on endoscopy, may warrant treatment with a PPI, as untreated it can predispose to Barrett esophagus, which can in turn predispose to esophageal cancer. This is, of course, not a medical opinion or recommendation; it's just what I've gleaned from my own research. Also, GERD can occasionally be asymptomatic or can manifest only as hoarseness. So it'd be important to involve a GI doctor whom you trust in assessing the best treatment for your GERD.

[Bobbie]

After years of using a PPI for acid reflux and
a hiatal hernia ( no C diff before and after) I switched to generic Zantac. It works better for me and is not as implicated in C,diff as PPIs are.

[justme]

I second what Bobbie said. I've used Lansoprazole (Prevacid) since I was diagnosed with a hiatal hernia about 9 years ago. I always used the OTC minimum dosage, but it didn't help my acid reflux much, but I was afraid (especially after C. Diff) to take more of it. I switched to Zantac minimum daily dosage and it has worked MUCH better for controlling the acid reflux. On doctor's orders, I go off the Zantac every 14+/- days for 72 hours to give my body a break. On about the third day, I do see a bit of the reflux return, but it is minimal. However, what works for some, may not work for others.

[BonSong]

I went ahead and read all through the Media reports, but they all mention PPIs - they are not mentioning H2 anatagonists such as Zantac. I guess they are seeing the connection between PPIs and C. Diff - but if there is a connection between H2 antagonists and c. diff, are they just missing it and focusing on the stronger drugs (PPIs?) I wish there were more info that could kind of demonstrate a PPI vs. H2 antagonist correlation.... when I do a search for H2 antagonists and c. diff, I do find studies that include them along with PPIs, kind of lumping them together.

I haven't had an upper endoscopy since I was 14. When I was 14, that GI doc did note that I had mild redness/irritation of my esophagus. My parents both struggle pretty badly with GERD, both are on either PPIs and H2 antagonists or both, and my dad even had h. pylori a few years ago. Based on all my symptoms and family history, I know I have it and it's really bad. Prior to c. diff, I used to take Zantac a lot. Like for days at a time. It did help.Maalox, Mylanta, TUMS, doesn't seem to do anything. Now I'm terrified to go near Zantac... but I'm really not good. I don't know what to do...

[BonSong]

http://digestivehealthinstitute.org/201 ... urn-drugs/ .... sigh

"The FDA has warned for some time that the use of proton pump inhibitors (PPIs) for heartburn increases the risk of Clostridium difficile-associated diarrhea. Now, a new review of 33 separate studies shows that prescription strength versions of the less potent heartburn drugs called H2 antagonists such as Pepcid, Tagamet, Zantac, and Axid, carry the same risk. The risk was greatest for hospitalized patients receiving antibiotics."

http://www.sciencedaily.com/releases/20 ... 131310.htm <-- the study

I guess there's my answer. :(

[AllisS]

Per the top link you cite, "The Fast Tract Digestion Heartburn is a clinically tested dietary approach to eliminate acid reflux by targeting small intestinal bacterial overgrowth (SIBO). The diet is designed to be effective without PPIs or H2 blocker drugs." I haven't yet explored the link to the diet, but perhaps there will be an option to try there. It's the long-term, continuous use of PPIs and histamine drugs such as Zantac that's said to pose the most risk. I've read at least one article that says taking these drugs on an as-needed basis could be effective, whereas doctors have typically recommended their continuous use. I took a PPI every morning for about 15 years, regardless of how I was feeling at the time, and Zantac at bedtime, again, regardless of whether I felt I needed it. Now I take no PPIs and limit my Zantac use to only those times when I have symptoms, so my use of it has dropped dramatically. GI doctors need to start being able to advise patients about how to lessen their dependence on PPIs and Zantac. I've never gotten more advice than just a proposed tapering schedule. Of all the specialties, GI is, in my opinion, near the top of the least helpful. It's geared toward testing, e.g., colonoscopy and endoscopy, and prescribing.