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Dear Dr. Roach: What is your opinion of the safety of a medicine like omeprazole for long-term use, versus a calcium-based antacid tablet, for reflux?

R.W.

Dear R.W.: Both treatments have some risks and some benefits. Proton pump inhibitors, like omeprazole (Prilosec), hike the risk of infection, both with Clostridium difficile and with pneumonias, based on their suppression of acid secretion. They can cut magnesium levels in the body, particularly if used with diuretics. There may be a small rise in hip fractures, about 5 more fractures per 10,000 who take PPIs. Recent studies have shown an association between PPIs and kidney disease and dementia: It’s not clear if this is due to the medication.

Calcium antacid tablets also have risks, the major ones being kidney stones and a possible increase in heart disease risk (one study showed about a 3 in 1,000 risk; other studies have shown no increase in risk).

One major concern, though: In people taking any medication long term for reflux disease, I want to be sure the diagnosis is correct. Unfortunately, too many people with serious conditions, including stomach and esophageal cancer, take these medications without ever getting a thorough evaluation, which everyone with long-lasting symptoms should have.

Email questions to ToYourGoodHealth@med.cornell.edu.

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