Increased usage of antacids among GERD patients, silent cause of ...

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New Delhi: India is witnessing a rise in cardiovascular diseases (CVDs), which is mostly due to sedentary lifestyles and consumption of highly processed unhealthy foods. This has come to the limelight once again as various celebrities have succumbed to CVDs in the last few months.
In recent years, the prevalence of gastro-oesophageal reflux disease (GERD), often known as acidity, has climbed to 30 per cent among Indians, with Kolkata having the highest rate of acidity and indigestion (38.5 per cent) and Surat having the lowest (21 per cent). According to Stanford University and Houston Methodist researchers, those who take proton pump inhibitors like antacids are 21 per cent more likely to suffer a heart attack than those who don’t. Furthermore, the use of antacids, which cause irregular heartbeats and plaque buildup in the arteries, increases the risk of developing cardiovascular diseases in people with GERD.
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Antacids link to CVDs
Antacids are one of the most commonly prescribed over-the-counter medications, and while they are generally safe and well-tolerated, they have been linked to cardiovascular disease in those who suffer from acid reflux.
Antacid active components comprise inhibitors which can be a silent cause of CVDs in GERD patients, stressing this, Dr Ashish Agarwal, Director, Cardiology, Aakash Healthcare, Dwarka said, “Proton pump inhibitors (PPIs), a form of antacid drug, are commonly taken for a range of health conditions. But, they need to be cautious about their use because a study has found that adults using the drug are 16–21 per cent more likely to have a heart attack than people not using the antacid. PPIs can adversely affect the endothelium, the teflon-like lining of the blood vessels.”
Adding to the link between acidity, antacids, and heart attack, Dr Manish Hinduja, Consultant-Cardio Thoracic & Vascular Surgery, Fortis Hospital, Mulund said, “Regular use of PPIs and commonly used antacids. eg pantoprazole is associated with coronary artery disease, as per a few reports as cardiac chest pain is commonly confused with acidity.”
“Patients having long-term heartburn even after taking antacids, should also undergo a cardiac examination, especially if they are showing cardiac risk factors.” he further added.
Under the Drugs Rules, 1945, certain drugs were included in Schedule K of the law, allowing drugs to be sold over-the-counter (OTC) by retailers with a valid licence, including antacids. The purpose of the new policy was to minimise treatment time and costs while also encouraging self-care without compromising one's health, but when such drugs are taken without proper doctors' guidance, it can contribute to a range of health problems.
Speaking about the use of antacids as an OTC drug, Dr Deepak Gupta, Medical Gastroenterologist, Apollo Hospitals, Navi Mumbai, stated, "It is commonly accessible over-the-counter, and many patients take it before seeing their doctor," he also mentioned that antacids have a market share of at least 20 per cent.
“Antacid market is growing. Since the pandemic acidity issues have increased and hence there is an increase in the over-the-counter (OTC) off-take of antacids” said Dr Rakesh Patel, Senior Consultant-Gastroenterologist, Fortis Hospital, Kalyan.
Dr Agarwal explained why there has been an increase in the usage of antacids by underlining an individual's diet, he said, "Lifestyle is one of the most pivotal factors behind triggering acidity. The most common cause is food. Consumption of citrus fruits, tomatoes, onions, chocolate, coffee, cheese, and peppermint causes acidity. Spicy foods or large meals can also be the root of distress and being overweight also increases acidity.”
“The major triggers for GERD are obesity, tobacco consumption or smoking, spicy & non-vegetarian diet, connective tissue disease, and use of medications like antibiotics, NSAIDs, antidepressants, and osteoporosis medication,” said Dr Shah.
Staying healthy and avoiding illness requires a well-balanced diet. A healthy diet can improve one's long-term health, but ignoring the importance of diet can also result in health issues. “The burden of heart disease is increasing at a fast pace and the major reasons for this are unhealthy lifestyle, physical inactivity, unhealthy diet, smoking, alcohol consumption and inappropriate sleep routines,” said Dr Ankur Phaterpekar, Director, Cath Lab and Interventional Cardiologist, Symbiosis Hospital, Mumbai.
Dr Patel responded to the matter of whether Indian foods play a role in acidity, he said, “The Indian diet if followed properly will not result in GERD, adding spices, aerated drinks, and fats to the diet is leading to acidity.”
Lesser-known adverse effects of antacids
Antacids are over-the-counter medications that efficiently cure acidity and indigestion by neutralising stomach acid; however, long-term usage of these OTC medications may have adverse implications on one's health. Regular usage and consumption might result in calcium and magnesium deficiencies and the long-term use has also been linked to renal problems and impairing the effectiveness of other medications
Dr Agarwal said, “Many antacid side effects are caused by not taking them as prescribed. Calcium is found in many antacids. An overdose of calcium can occur if one takes too much or for longer than recommended. Too much calcium can lead to nausea, vomiting, changes in mental status, and kidney stones. It can also lead to alkalosis, a condition in which the body doesn’t make enough acid to function properly.”
He further mentioned that “Antacids can only soothe, not cure the condition, and one should always consult a doctor before choosing the right antacid.”
Dr Gupta added on the safety of antacid use in everyday life, saying, “Antacids help in minimising the symptoms connected to hyperacidity, mainly the burning feeling in the abdomen, bloating and epigastric discomfort however antacids are not to be used on a regular basis.”
“Antacids (PPI) are safe if taken at per right doses, by the right patient and for the right indication, but if used extensively, it will lead to side effects. Side effects like kidney diseases, bone density loss, opportunistic infections, magnesium deficiency and B12 deficiency. So, one should use the medicine only if prescribed as antacid liquids have salts which can cause problems if taken unsupervised for long” said Dr Patel.
Dr Gupta also said, “Antacid's regular consumption is also known to cause kidney issues on long term usage.”
“The use of acidity medication tablets is highly widespread among Indians, and long-term use of these tablets can be harmful and have a major impact on one's health,” Dr Shah.
Antacids are among the most widely prescribed over-the-counter medications and are generally safe when taken in the recommended dosages and for the intended purpose, but they may have adverse side effects if used excessively without proper doctor guidance.