Monday, 2 May 2016

PPIs side effects – are we at risk from reflux drugs?


Proton pump inhibitors(PPIs) are the most commonly prescribed medication for reflux symptoms, such as heartburn and indigestion. PPIs include esomeprazole (Nexium), lansoprazole (Zoton), omeprazole (Losec), pantoprazole (Protium) and rabeprazole (Pariet).

PPIs side effectsPPIs reduce the amount of acid that your stomach produces by blocking the proton pump. The proton pump, found in the cells of the stomach lining and known to the medically-minded as the ‘hydrogen-potassium adenosine triphosphatase enzyme system’, is the site of acid production.
Most people who take a PPI do not develop any side effects. Minor side-effects of PPIs tend to include nausea, vomiting, abdominal pain, flatulence, diarrhoea, constipation and headache.
However, there have been an increasing number of reports associating long-term PPI usage with more serious side effects – let’s take a look at some of the claims.
PPIs and dementia
A 2016 study by researchers from the German Center for Neurodegenerative Diseases published in medical journal JAMA Neurology first reported a link between PPIs and dementia.
According to the report, people taking PPIs had a 44 per cent higher risk of developing dementia in a seven-year period compared with those not taking the drugs. People aged 75 or older who regularly take PPIs had an increased risk of the disease. The report concluded that the avoidance of PPI medication may prevent the development of dementia.
However, the link with dementia is uncertain and experts say there are other factors not measured in the study that could explain the increased risk of reflux.
PPIs and kidney failure
People who use PPIs have a 20 to 50 per cent higher risk of chronic kidney disease compared with those who don’t, according to researchers at Johns Hopkins University in Baltimore in a study published in JAMA Internal Medicine in 2016.
In previous studies, PPIs have also been linked to short-term kidney problems, such as acute kidney injury and an inflammatory kidney disease called acute interstitial nephritis. One study claims that patients on PPIs are up to three times more likely to suffer acute interstitial nephritis than those not taking PPIs.
PPIs and magnesium deficiency
PPIs have been linked to hypomagnesaemia – a deficiency of magnesium in the blood – if taken for prolonged periods of time (at least three months, but most cases occurred after a year of treatment).
Researchers believe PPIs may lead to changes in intestinal absorption of magnesium. If magnesium levels are low enough it can cause problems such as muscle weakness and tremors, seizures and irregular heartbeat.
It is perhaps not surprising that reducing stomach acid levels by long-term PPI use may also reduce the absorption of other vitamins and minerals, including calcium and vitamin B12.
PPIs and Clostridium difficile infection
PPIs have been associated with a moderate increase in the risk of developing Clostridium difficile, also known as C. difficile or C. diff – an infection of the bowel which can cause diarrhoea and painful stomach cramps.
PPIs and bone fractures
Long-term usage of PPIs has been linked with the risk of bone fracture, especially hip, wrist or spine – studies suggest the risk of fracture is increased by 10–40 per cent. A 2012 report found an association between PPIs and an increased risk of hip fracture, particularly among women with a history of smoking, although a separate report warns that there is no clear mechanism through which PPI therapy increases the risk of fracture.
PPIs have also been associated with an increased risk of pneumonia and SCLE(subacute cutaneous lupus erythematosus) – a non-scarring dermatosis that can develop in sun-exposed areas.
Professor Peter Dettmar says: “Research has found that PPIs offer an effective short-term treatment for reflux, but no medicines are completely safe or without side effects. It is important to weigh the risks and benefits before taking any medication.”
“People should only really be taking PPIs if they have a confirmed reflux diagnosis, not just because reflux is suspected. Using PPIs for more than four weeks can make it quite hard to come off the drug once you’re on it. Unfortunately, a large number of patients are taking PPIs for no clear reason, such as for symptoms of heartburn that no longer exist.”
“If you are currently taking non-prescription PPIs, do not use them for more than four weeks without consulting a doctor and always take medication as advised by a healthcare professional.”

Monday, 11 January 2016

Reflux and wheezing - how Peptest helped me

Symptoms of Laryngopharyngeal reflux (LPR) – when stomach contents backflow into the airways – can include wheezing, shortness of breath, hoarseness, cough and difficulty swallowing.

These symptoms are often worse at night, which can have a negative impact on your sleep and leave you feeling tired during the day.

Two years ago, Ian Palmer (pictured), a 57-year-old business consultant from Hull, started wheezing at night and often woke up due to his heavy breathing.

Ian explains: “I’ve always been reasonably fit and healthy, but at the age of 55 I started wheezing and struggled to sleep through the night without waking up. Symptoms that seemed to be worse when I slept on my left-hand side.”

Following a visit to the doctor, Ian was diagnosed with asthma and prescribed an inhaler. However, this only made a ‘marginal difference’ to his symptoms and Ian then, on occasions started to suffer from a shortage of breath.

“I underwent a lung function test and X-rays, which came back clear, and was prescribed a different inhaler and steroids. I also tried standard Gaviscon, as the GP suspected some form of acid-reflux problem. However, three to four months later, my symptoms remained and the shortness of breath started to concern me,” says Ian.

A friend suggested to Ian that his symptoms were often associated with reflux disease and suggested he try Peptest. Peptest is a non-invasive diagnostic for reflux disease – it identifies the presence of the stomach enzyme pepsin in saliva samples – considered a reliable marker for the reflux of gastric juice.

“After taking Peptest, my results showed very high levels of pepsin, especially after my midday and evening meals. I took the results to my doctor, along with a recommendation that I be prescribed Gaviscon Advance. Within the space of a few weeks of taking the prescription, my symptoms of two years pretty much stopped.”

“I can now sleep in any position, am not suffering any shortness of breath and feel so refreshed. I didn’t realise that I had become so tired and am so relieved that something as simple as a saliva test appears to have resolved my problem. I still have a preventative inhaler but at the moment I can’t see me needing it at all in the near future.”

You can order a Peptest collection kit online.

Saturday, 2 January 2016

Tackling Reflux – keep a symptom diary

Symptoms of reflux disease, such as heartburn or indigestion, are often ignored or played down by people. While other sufferers will self-medicate through the use of over-the-counter antacids and acid-reducing treatments.

However, the NHS warns that suffering from heartburn most days, for three weeks or more, could be a sign of oesophageal or stomach cancer, so finding it earlier makes it more treatable.

One way to keep an eye on your symptoms is to keep a symptom diary. It’s a simple way to record symptoms or activities in an organised manner over a certain length time and can help with diagnosing and managing your condition.

Make a note how often and what time of day a symptom, such as heartburn, appears and its severity. Keep a record of your diet (what you eat, the quantity and time of day), lifestyle activities, sleeping patterns and any medication that you have used and how helpful they were.

It is recommended that you keep a symptom diary for a few weeks to get an accurate overview of what is happening to help with an accurate diagnosis and ultimately the best treatment.

Symptoms typically associated with gastro-oesophageal reflux disease (GORD) usually occur at distinct times and include heartburn and regurgitation. Symptoms associated with Airway Reflux and laryngopharyngeal reflux (LPR) are often continuous and include hoarseness, lump in the throat, sore throat, chronic cough, throat clearing, voice changes, trouble swallowing and shortness of breath.

Other symptoms that are also associated with reflux include asthma, sleep apnoea, tooth decay and even snoring.

Wednesday, 23 December 2015

Wishing you all a Merry Christmas & a Happy New Year!

2015 has come and gone and what a year it’s been!

We have enjoyed successful trips to China with our esteemed distributor MAAB International – taking in the sights of Shanghai, Beijing and learning about developments in GI medicine in China.

Over in Ireland, we teamed up with a fantastic distribution partner in Bodycare, and we also secured new distributors in India, Singapore and Jordan.

We were thrilled with the publication of our exciting work with partners in the UK and the Czech Republic and delighted to achieve the International Organization for Standardization (ISO) 9001:2008 certification.

We also continue our research programmes into new diagnostic products behind the scenes with our growing number of collaborators and we hope to bring exciting news of these next year.

We’d like to thank all our distributors, customers, research partners and collaborators across the world – we hope you have a wonderful 2016.

Tuesday, 22 December 2015

Peptest detects airways reflux in pulmonary diseases

Peptest has been used to help identify airways reflux in a range of pulmonary diseases, according to research published in The Clinical Respiratory Journal.

The Peptest diagnostic test detects pepsin in expectorated saliva and is established as a quick and easy measure of the reflux of gastric contents responsible for gastro-oesophageal reflux disease (GORD) and extra-oesophageal reflux (EOR) into the laryngopharynx.

Researchers hypothesised that detection of pepsin using Peptest could provide objective evidence of a contribution of airways reflux in the pathology of a range of pulmonary diseases, such as chronic cough, bronchial asthma, idiopathic pulmonary fibrosis (IPF), chronic obstructive pulmonary disease (COPD) and cystic fibrosis.

The study assessed more than 350 patients presenting with various respiratory/pulmonary diseases and four out of five patients showed evidence of reflux or aspiration of gastric contents using detection of pepsin in expectorated saliva using Peptest.

Pepsin was detected even in patient’s prescribed PPI medication that clearly influenced acid secretion but not reflux of pepsin.

The researchers concluded that reflux above the upper oesophageal sphincter and into the airways may not be causative of these investigated conditions but, “the presence of damaging pepsin will certainly be a negative influence that may increase disease severity or reduce the impact of pulmonary medication/therapy”.

So what does this mean in terms of patient’s quality of life and treatment? Peptest's reflux diagnostic test now makes it a lot easier for clinicians to determine the presence of reflux and the potential risks of disease exacerbation and hospitalisation. This will lead to better control of a patient's respiratory/pulmonary disease condition.

Friday, 18 December 2015

Reflux: Top tips for improving sleep


People who suffer from reflux symptoms at night, including heartburn, breathing difficulties and indigestion, will often struggle to get a decent night’s sleep.

If you're waking frequently and struggling with tiredness in the morning, there are some simple tips you can try to enjoy a good night's rest.

1) Try sleeping on your left side
It is widely believed that sleeping on your left side can help aid digestion. Because the stomach 'hangs' naturally when you lie on your left side, experts say this means it can digest food properly, whereas if you lie on the right side, the stomach will hang in an unnatural position. A study of digestive reflux in The Journal of Clinical Gastroenterology found that the total amount of reflux time was significantly greater when sleeping on the right.

2) Elevate your upper body
When you lay flat in bed, your throat and stomach are at the same level, making it easy for stomach contents to flow up your oesophagus and into the airways. Try elevating your body so that your head and chest are raised by at least 15 to 20 cm. Gravity will then prevent your stomach contents from flowing into the oesophagus. You can buy reflux pillows and wedges to support your sleeping position.

3) Avoid large, late-night meals
Experts advise you to avoid eating meals two to three hours before bedtime to reduce the levels of stomach acid present when you lie down and to allow the stomach to partially empty its contents before you sleep. Because large meals put pressure on your stomach, try eating smaller portions on an evening.

Friday, 6 November 2015

Reflux saliva tests: behind the scenes at the Peptest laboratory

Peptest is a rapid, accurate, painless and inexpensive saliva test that tells you conclusively if you are suffering from reflux disease.

Saliva samples can be collected by patients at home in sample tubes, which contain citric acid as a preservative, and can be posted to our laboratories for analysis.

In the laboratory, we test the saliva samples for the presence of a stomach enzyme called pepsin. Pepsin is only found in the stomach, so if it is found outside in saliva then we know it has been refluxed.

Jeanine, our Research Technician, looks after saliva samples once they arrive at the laboratory.

Here she describes the Peptest analysis procedure, which typically takes about 22 minutes to complete.

“Firstly, I will spin down the saliva sample in a centrifuge machine for five minutes, at a rate of 4000 rpm, to remove any insoluble material from the saliva and leave a clear supernatant layer.

Then, using an automated pipette, I will take out a sample of this layer and dilute it with a migration buffer solution before mixing this sample in a vortex mixer for about 10 seconds.

A sample is then removed and added into the well of the Peptest device and after a few minutes a blue line will appear on the device – this line is a control line and confirms that the test is working correctly.

Within 15 minutes, a coloured line will become visible through the viewing window at the test line if there is pepsin present in the saliva.

The test line is visible if Pepsin is present at a concentration of 16ng/ml or more.

I can also measure the concentration or intensity of pepsin in the sample using an electronic lateral flow reader.

A second member of the Peptest team, such as Andrew our Laboratory Manager, will clarify the readings and all samples will then be removed as clinical waste.

We do our best to send results to patients on the same day as testing their sample – typically this is within 24 hours of a sample arriving at the laboratory.”

Without early diagnosis and treatment reflux can, in time, lead to damage to the oesophagus and a condition called Barrett’s Oesophagus that in some cases leads to oesophageal cancer. In certain cases it is also responsible for cancer of the Larynx.

Find out more about Peptest and where you can order your test at our website.

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