Nexium side effects

[patchworker]

I've been taking Nexium 40mg daily for more than three years, and i'm worried about the side effects. i'm told it can cause osteoparosis if taken over a long period, but if I don't take it, the Barretts may come back to what's left of my esophagus. Can anyone advise me?

[gail221]

The information available to professionals on the company datasheet states

"Proton pump inhibitors, especially if used in high doses and over long durations (>1 year), may modestly increase the risk of hip, wrist and spine fracture, predominantly in the elderly or in presence of other recognised risk factors. Observational studies suggest that proton pump inhibitors may increase the overall risk of fracture by 10-40%. Some of this increase may be due to other risk factors. Patients at risk of osteoporosis should receive care according to current clinical guidelines and they should have an adequate intake of vitamin D and calcium."

My feeling is that the risk of the Barretts coming back would outweigh the risk of osteoporosis - you can always take calcium and vitamin D supplements if you're worried about it

[Hidden]

Nexium is a brand name for esompeprazole which is a proton pump inhibitor. These switch off the production of stomach acid, and, generally speaking, will be necessary to combat the stomach acid that might be coming up towards your throat. The production of stomach acid will depend upon how much of your stomach may have been removed in the surgery. But the chances are that the valve between your oesophagus and stomach is no longer there after the operation. Hence the acid does not get prevented from rising.

The way in which the body converts calcium for maintaining strength of bones does depend upon stomach acid, so it is quite true that there is a a side effect of taking PPI medication. But PPIs are taken by many thousands of patients for vastly greater number of reasons than having had an oesophagectomy, and they are safe. But, long term, they may have a contributory effect towards osteoporosis.

The thing to do is to see your GP who hopefully can arrange a bone density scan. If this shows that your bone density might be a cause for concern you might be prescribed medication to try and prevent bones becoming thinner.

How this is is prescribed might be an issue. Your body will not absorb medication at quite the same rate as normal because of your shortened digestive system, so sometimes medication might be prescribed in a liquid, or non-pill format.

There is sometimes a slight residual risk of Barrett's developing in the remains of your oesophagus, but assuming that you are clear at the moment, it is a very slow process, firstly to develop Barretts, and then for any further development to become malignant. The usual rate quoted is 0.5% per patient year after Barrett's starts (so that means that if you started a Barrett's condition today, there would be a 20% chance of developing adenocarcinoma in the next 40 years) Some studies put this rate as lower - 0.33% per patient year - but it is also true that they are not geared towards those who have already had surgery. But the figures also do not take into account those who are on PPIs which should have a preventive effect on Barrett's developing.

On the basis that you have been prescribed nexium, and your bone density is OK, I would suggest that you carry on taking it, but discuss the situation next time you see your surgeon.

[chris_usa]

As a licensed pharmacist and a total transhiatal esophagectomy patient, I feel the need to add to the previous responses. I had been on high-dose PPI (Prevacid 30mg twice daily) therapy for over ten years before the esophagectomy for end-stage achalasia. I have now been diagnosed, per DEXA, with osteoporosis. It is unknown if this is due to the PPI, the malnutrition from the severe achalasia, or some effect from the esophagectomy. It is quite possibly due to a combination of those factors.

As a patient faced with the tough question of osteoporosis vs PPI therapy, you have no easy answers. Supplementation is not necessarily a good answer, because the lack of acid in the stomach (and altered physiology after the surgery) make absorption of calcium difficult. Osteoporosis sounds like a minor entity as compared to esophageal cancer until someone gets a hip fracture.

It is unlikely that any clinician would give you the oral treatments for osteoporosis based on your history and surgery, as the risk of esophageal damage is too high. That only leaves parenteral therapies, which do come with possible side effects, one of the most significant being jaw osteonecrosis. And if you are like me and had major demineralization of the teeth after the esophagectomy, that risk of jaw fractures is a real and present danger.

I do not mean to scare anyone, but I think that the previous responses did not adequately deal with the gravity of your decision. This is a significant issue that needs to be thought out carefully and with the help of your surgeon and possibly Endocrinology.

I chose to forgo treatments for osteoporosis, supplement with calcium as best as possible, and avoid PPIs. I take ranitidine 150mg once or twice daily. I do as much weight bearing activity as I can, and I am awaiting a consult with Endocrinology.

[patchworker]

Thank you everyone for your replies.

I shall make a note of all the points you raise, to discuss with my GP.

I have an appointment with my surgeon next month for my usual check up, so I can ask for his advise.

It's all rather scary, I would have thought the matter would be dealt with routinely for anyone having our surgery, but it obviously isn't.

Thanks again,

Jane

[Hidden]

Thanks again to Chris_USA! The advice about seeing an endocrinologist is a good one. We had one member who was advised to do this by a surgeon who came to one of our talks, and they did have a bit of a struggle to get their GP to refer them to the endocrinologist recommended by the surgeon (probably because it was also in a different NHS trust perhaps)