The American Academy of Family Physicians says the following foods can trigger or aggravate heartburn:
The two reports from researchers at Wake Forest University School of Medicine support findings released a few weeks ago that anticholinergic drugs -- which treat a variety of diseases and conditions, including acid reflux, Parkinson's disease and urinary incontinence -- may cause older people to lose their thinking skills more quickly than those who don't take the medicines.
Anticholinergic drugs work by stopping acetylcholine, a chemical that enhances communication between nerve cells in the brain, from binding to its receptors in nerve cells.
In the first Wake Forest study, older adults taking anticholinergics became more likely to walk more slowly and to need help in other daily activities.
"These results were true even in older adults who have normal memory and thinking abilities," study author Dr. Kaycee M. Sink said in a prepared statement. "For older adults taking a moderately anticholinergic medication, or two or more mildly anticholinergic medications, their function was similar to that of someone three to four years older."
Common anticholinergic medicines cited in the study included the blood pressure medication nifedipine (Adalat or Procardia), the stomach antacid ranitidine (Zantac) and the incontinence medication tolterodine (Detrol).
The findings, which involved more than 3,000 people, average age 78, were scheduled to be presented Saturday at the American Geriatrics Society annual meeting, in Washington, D.C.
In a separate Wake Forest study, published online in April in the Journal of the American Geriatrics Society, Sink found that older nursing home residents who took medicines for dementia along with anticholingerics for incontinence declined in function 50 percent faster than those only treated only for dementia.
"Over a year's time, the decline we observed would represent a resident going from requiring only limited assistance in an activity to being completely dependent, or from requiring only supervision to requiring extensive assistance in an activity," said Sink, an assistant professor of internal medicine-gerontology at Wake Forest.
The seniors in the second study had completed at least two consecutive prescriptions for cholinesterase inhibitors, a family of drugs used to treat dementia by increasing levels of acetylcholine. These include donepezil (brand name Aricept), galantamine (Razadyne), rivastigmine (Exelon) and tacrine (Cognex).
About 10 percent of those studied were also taking either oxybutynin or tolterodine, the two most commonly prescribed drugs for urinary incontinence.
"The two drugs are pharmacological opposites, which led us to hypothesize that the simultaneous treatment of dementia and incontinence could lead to reduced effectiveness of one or both drugs, Sink said.
As an estimated 33 percent of people with dementia also take a medicine to control incontinence, this finding is especially alarming.
The two studies suggest that physicians should carefully consider the implications when prescribing anticholingeric medications to older adults.
More information
The U.S. National Institute on Aging has more about older adults and medications.
]]>Two forms of Nexium (esomeprazole magnesium) were approved for younger children -- a delayed-release capsule and a liquid form. Doses approved for this age group are half of those approved for older children, the agency said. The drug was previously approved for children ages 12 to 17.
Nexium is among a class of drugs called proton pump inhibitors, which limit production of stomach acid and help heal erosion of the lining of the esophagus.
Common side effects among younger children who used Nexium were headache, diarrhea, abdominal pain, nausea, gas, constipation, dry mouth, and fatigue. The drug's safety and effectiveness haven't been evaluated in children younger than 1 year old, the FDA said.
Nexium is manufactured by AstraZeneca.
More information
The FDA has more about this drug.
]]>The National Sleep Foundation offers these suggestions to keep GERD symptoms calm at night:
MONDAY, Dec. 10 (HealthDay News) -- A U.S. government review of the popular heartburn drugs Prilosec and Nexium found no evidence of increased heart risks, health officials said Monday.
The announcement followed a three-month safety review after reports of possible heart risks emerged from two preliminary studies. But detailed data from both studies, plus another 14 studies, showed no heightened risk associated with long-term use of the drugs, U. S. Food and Drug Administration officials said.
Dr. Paul Seligman, associate director of the FDA's Office of Safety Policy and Communication at the Center for Drug Evaluation and Research, told reporters that the agency "had completed our safety review, and our current assessment is that studies do not show a risk for heart attack or heart-related problems."
In a prepared statement released earlier in the day, the FDA also said: "Based on everything now known at the agency, the reported difference in the frequency of heart attacks and other heart-related problems seen in the earlier analyses of the two small long-term studies does not indicate the presence of a true effect."
And it added, "FDA recommends that health-care providers continue to prescribe, and patients continue to use, these products as described in the labeling for the two drugs."
Dr. Philip O. Katz, chairman of gastroenterology at Albert Einstein Medical Center in Philadelphia, agreed that these drugs are safe and that patients shouldn't hesitate to use them.
"This is altogether good news," Katz said. "It is reassuring to physicians and the public, who are using these drugs on a widespread basis, that this is not deemed to be an issue."
Both drugs are made by the British pharmaceutical company AstraZeneca. In May, the company gave the FDA findings from two small, preliminary trials that were designed to test the effectiveness of the drugs, compared with surgery, for severe gastroesophageal reflux disease (GERD).
During the trials, some cardiac "events" were seen among study participants, hinting that long-term use of Prilosec and Nexium could increase the risk of heart attack, heart failure and heart-related sudden death, the FDA said at the time.
Because of these concerns, AstraZeneca gave the FDA more detailed data from the two initial studies as well as findings from 14 other studies -- one 14 years in length -- that compared the drugs with a placebo.
The more complete data showed that patients taking Prilosec had a lower risk of heart problems than patients taking a placebo. And findings from the ongoing Nexium trial found no difference in heart problems between patients taking the drug and those undergoing surgery for GERD, the FDA statement said.
In a prepared statement released Monday, AstraZeneca said it "supports the conclusion made by the FDA that the overall benefit/risk profiles of omeprazole (Prilosec) and Nexium remain unchanged. AstraZeneca continues to be confident in the safety profiles of omeprazole and Nexium."
However, Seligman did say that the FDA continues to investigate whether the drugs increase the risk of hip fracture. A report in the Dec. 27, 2006, issue of the Journal of the American Medical Association found that people 50 and older who took Prilosec or Nexium had a 44 percent higher risk of hip fracture than people not taking these drugs.
Prilosec and Nexium are drugs known as proton pump inhibitors, which treat the symptoms of GERD and other conditions caused by excess stomach acid.
AstraZeneca says more than 1 billion patients worldwide take the drugs, according to Bloomberg News.
Prilosec is also available over-the-counter to treat frequent heartburn.
More information
For more on GERD, visit the U.S. National Institute of Diabetes and Digestive and Kidney Diseases.
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