Acid Reflux Cause Cancer

Q: For hiatal hernia w/reflux, I have been prescribed Prilosec 20 mg. once a day. I'm quite comfortable taking it, but worry about possible stomach cancer down the line, because of no acid secretion. Dr. assures me it has been used in Europe long-term with no reported cases of stomach cancer, and I think she said FDA is on the point of approving it for U.S.? Not sure. Because I'm nervous about Prilosec, she has prescribed Zantac 150 mg. 2x daily as a substitute. Says Zantac does not stop *all* stomach acid. With the Zantac, I still have to pop Tums several times a day, so am not 100% comfortable. Now to the question (if indeed it has an answer!): Is the minor but continuing discomfort of the Zantac worth it? Put another way, does it give me any real edge over the complete comfort of the Prilosec?

A:In rats omeprazole has caused some cancers of a rare type (gastrinoma) which are possibly related to the nearly complete acid suppression this drug causes. This acid suppression causes extremely high blood levels of a hormone that is trying to stimulate the stomach to start making acid again. In some humans similar tumors have occurred, but the situation as murky, as it is likely that some of these tumors were present prior to starting the omeprazole, and were actually causing the hyperacidity in the first place. On the other hand, acid reflux over a period of time can also cause cancer, this time of the esophagus. First a condition called Barrett's esophagitis occurs, in which the esophageal lining is damaged from repeated exposure to stomach acid. Omeprazole can decrease the chance of the esophageal cancer from happening. If your reflux esophagitis is mild, your risk of esophageal cancer is low. So I can't give you an exact answer to your particular case. Maybe this info will be helpful in your discussions with your physician though. I use omeprazole in many of my patients with severe esophagitis. Its effective and probably safe enough. For mild esophagitis, lesser measures are often effective: You might consider some of thes antireflux measures: Stop or reeduce the dosages of other drugs which worsen esophageal reflux, if this can be safely done. Elevate the head of your bed by 12 to 18 inches (enough to let gravity drain your stomach acid, but not enough to fall out of bed.) This can be accomplished by putting blocks under the legs at the head of your bed. Put some rubber skid stops between the legs and the blocks so they don't fall off the blocks at night. Else you'll get a rude awakening! Take a TUMS at bed time. Let 4-6 hours elapse between your evening meal and your bed time. Avoid all tobacco use. Limit alcohol to less than two drinks per day. If you are obese, loose some weight. Start a low fat diet, and do some exercise. Even walking would help. Losing 10 kilograms will decrease the pressure in your abdomen enough to reduce the esophageal reflux signficantly. Eat 6 small meals instead of 3 big ones.

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