Long-term effects of Prevacid, etc.

[Frank__0]

  Hello,
  I've been recently diagnosed with "sliding hiatus hernia" from an E.G.D, and "Retroflexed views of the anal verge show internal hemorroids (hemorrhoids)." from a colonoscopy. All other 'nasties' have been ruled out (relief!).
  My doctors have prescribed Prevacid 30mg, Propulsid 20mg, and Colace 100mg, 1-3 x per day. For the prior three years I had been taking Pepsid (20mg ea 2-3 x times a day) - this gave diminishing relief, prompting the two tests.
   Where could I get information on the long-term effects of these prescriptions? (including Pepsid)
   What does 'sliding' in this context mean?
  Both doctors have been offended by this 'long-term' question; telling me 'not to worry'. I trust their competency.
  Yet, I am reluctant to indefinitely take 'acid-blockers' and 'digestive stimulants' without understanding the risks. Since 'mesh' surgery may or may not relieve my life-long acid reflux and regurgitation (I'm a 44 yr old male), and thus far the Prevacid/Propulsid duo has provided only some relief; I need to prepare for discussions with my doctor about long-term repair of this situation. (After all, no one can be fully informed about all things, including the good Doctor)
  I believe I understand that the Colace should not be required as a maintenance therapy; just long enough to allow the hemorroids (hemorrhoids) to heal.
  Thank You (great site, K.U.T.G.W.!)
  Frank 9-27-1998
Dear Frank,
A sliding hiatal hernia refers to a laxity in the supporting structures keeping the stomach in the abdominal cavity. Because of the weakness in muscles and ligaments, the position of the stomach lies higher than its proper anatomic position (in the chest cavity). You can try searching the internet for the medicines you want to find information about. Briefly histamine receptor antagonists such as famotidine (Pepcid) have been around for years. They are considered very safe with a good side effect profile and have been used long term without many adverse effects. Prevacid (lansoprazole) and Prilosec (omeperazole) belong to a class of medication called proton pump inhibitors. They are strong inhibitors of stomach acid secretion. They are generally highly effective in treating patients with acid peptic disorders (such as gastroesophageal reflux or peptic ulcer disease). They are newer agents, but have been successfully used in Europe in patients with gastroesophageal reflux disease with few side effects (headache, constipation, diarrhea, abdominal pain, gas to name a few). Reports of patients in Europe having taken omeperazole for five years at a time without ill effects are available. Cisapride (Propulsid) is a prokinetic agent which accelerates gastric emptying and tightens the lower esophageal sphincter. It is generally a safe drug with few side effects (mainly diarrhea). However, in patients with underlying heart disease and dysrhythmias the drug is contraindicated. Important drug interactions between cisapride and a number of medications (antihistamines, certain antibiotics and antifungal drugs) can cause fatal cardiac dysrhythmias. Patients who require long term medical treatment for gastroesophageal reflux disease might benefit from anti-reflux surgery. This procedure can now be done laparoscopically minimizing recovery time. It is important to identify a surgeon who has specific expertise in anti-reflux surgery and to be comfortable with the risks, benefits and alternatives of this operation. I hope you find this information helpful.
This response is being provided for general informational purposes only and should not be considered medical advice or consultation. Always check with your personal physician when you have a question pertaining to your health.
If you would like to be seen at our institution please call 1-800-653-6568 our Referring Physicians' Office and make an appointment to see Dr. Muszkat, one of our experts in Gastroenterology.
HFHSM.D.-ym
*Keywords: gastroesophageal reflux, medical therapy