Common medicines used to treat conditions including heartburn, reflux, indigestion and stomach ulcers may be the subject of a class action lawsuit in Australia.

Lawyers are exploring whether long-term use of these over-the-counter and prescription drugs are linked to stomach cancer or kidney disease.

The potential class action follows the settlement of a related multi-million dollar lawsuit in the United States. Last year, international pharmaceutical company AstraZeneca settled for US$425 million (A$637 million) after patients made the case that two of its drugs caused significant and potentially life-threatening side effects.

Specifically, patients claimed the company’s drugs Nexium (esomeprazole) and Prilosec (omeprazole) increased the risk of kidney damage.

Which drugs are involved in Australia?

The class of drugs we’re talking about are “proton pump inhibitors” (sometimes called PPIs). In the case of the Australian potential class action, lawyers are investigating:

• Nexium (esomeprazole)
• Losec, Asimax (omeprazole)
• Somac (pantoprazole)
• Pariet (rabeprazole)
• Zoton (lansoprazole).

Depending on their strength and quantity, these medicines are available over-the-counter in pharmacies or by prescription.

They have been available in Australia for more than 20 years and are in the top ten medicines dispensed through the Pharmaceutical Benefits Scheme.

They are used to treat conditions exacerbated by stomach acid. These include heartburn, gastric reflux and indigestion. They work by blocking the protein responsible for pumping acid into the stomach.

These drugs are also prescribed with antibiotics to treat the bacterium Helicobacter pylori, which causes stomach ulcers and stomach cancer.

What do we know about the risks?

Appropriate use of proton pump inhibitors plays an important role in treating several serious digestive problems. Like all medicines, there are risks associated with their use depending on how much and how long they are used.

When proton pump inhibitors are used appropriately for the short-term treatment of stomach problems, they are generally well tolerated, safe and effective.

Their risks are mostly associated with long-term use (using them for more than a year) due to the negative effects from having reduced levels of stomach acid. In elderly people, these include an increased risk of gut and respiratory tract infections, nutrient deficiencies and fractures. Long-term use of these drugs in elderly people has also been associated with an increased risk of dementia.

In children, there is an increased risk of serious infection associated with using these drugs, regardless of how long they are used.

How about the cancer and kidney risk?

Currently, the Australian consumer medicine information sheets that come with the medicines, like this one for esomeprazole, do not list stomach cancer or kidney injury as a risk associated with using proton pump inhibitors.

So what does the evidence say about the risk?

Over the past few years, there have been large studies based on observing people in the general population who have used proton pump inhibitors. These studies have found people who take them are almost two times more likely to develop stomach cancer and 1.7 times more likely to develop chronic kidney disease when compared with people who are not taking them.

In particular, these studies report that users of the drugs lansoprazole and pantoprazole have about a three to four times higher risk than non-users of developing chronic kidney disease.

While these observational studies show a link between using the drugs and these outcomes, we cannot say from this evidence that one causes the other.

What can I do if I’m worried?

Several digestive conditions, especially reflux and heartburn, may benefit from simple dietary and lifestyle changes. But the overall evidence for these is not strong and how well they work varies between individuals.

But it may help to avoid large meals within two to three hours before bed, and reduce your intake of fatty food, alcohol and coffee. Eating slowly and getting your weight down if you are overweight may also help your symptoms.

There are also medications other than proton pump inhibitors that can be used for heartburn, reflux and stomach ulcers.

These include over-the-counter antacids (such as Gaviscon and Mylanta), which work by neutralising the acidic environment of the stomach.

Alternatives for prescription drugs include nizatidine and famotidine. These work by blocking histamine receptors in the stomach, which decreases stomach acid production.

If you are concerned about your use of proton pump inhibitors it is important to speak with your doctor or pharmacist before you stop using them. That’s because when you have been using them for a while, stopping them may result in increased or “rebound” acid production.

Nial Wheate, Professor and Director – Academic Excellence, Macquarie University; Joanna Harnett, Senior Lecturer – Sydney Pharmacy School, Faculty of Medicine and Health, University of Sydney, and Wai-Jo Jocelin Chan, Pharmacist and Associate Lecturer, University of Sydney

This article is republished from The Conversation under a Creative Commons license. Read the original article.

Extreme heat is increasingly common in Australia and around the world and besides making us uncomfortable, it can harm our health. For example, exposure to extreme heat can exacerbate existing medical conditions, or cause problems such as heat stroke.

Due to a combination of physiology and behaviour, children are potentially more vulnerable to severe heat-related illness such as heat stroke or heat exhaustion.

But these are not the only heat-related health issues children might experience on a very hot day. In a new study, we looked at emergency department (ED) visits and unplanned hospital admissions among children in New South Wales on heatwave days.

We found a significant increase in children attending hospital compared to milder days – with a range of health issues.

Why are children more vulnerable in the heat?

Sweating is the main way we lose heat from our bodies and cool down.

Children have a greater skin surface area to body mass ratio, which can be an advantage for sweating – they can lose more heat through evaporation for a given body mass. But this also means children can lose fluids and electrolytes faster through sweating, theoretically making them more susceptible to dehydration.

Meanwhile, younger children, particularly babies, can’t sweat as much as older children and adults. This means they can’t cool down as effectively.

Children in general also tend to engage in more outdoor physical activity, which might see them more exposed to very hot temperatures.

Further, children may be less in-tune to the signals their body is giving them that they’re overheating, such as excessive sweating or red skin. So they might not stop and cool down when they need to. Young children especially may not recognise the early signs of heat stress or be able to express discomfort.

Our study

We wanted to examine children’s exposure to extreme heat stress and the associated risks to their health.

We measured extreme heat as “heatwave days”, at least two consecutive days with a daily maximum temperature above the 95th percentile for the relevant area on a universal thermal climate index. This ranged from 27°C to 45°C depending on the area.

We assessed health outcomes by looking at ED visits and unplanned hospital admissions among children aged 0–18 years from NSW between 2000 and 2020. This totalled around 8.2 million ED visits and 1.4 million hospital admissions.

We found hospital admissions for heat-related illness were 104% more likely on heatwave days compared to non-heatwave days, and ED visits were 78% more likely. Heat-related illness includes a spectrum of disorders from minor conditions such as dehydration to life-threatening conditions such as heat stroke.

But heat-related illness wasn’t the only condition that increased on heatwave days. There was also an increase in childhood infections, particularly infectious enteritis possibly related to food poisoning (up 6% for ED visits and 17% for hospital admissions), ear infections (up 30% for ED visits and 3% for hospital admissions), and skin and soft tissue infections (up 6% for ED visits and 4% for hospital admissions).

We know many infectious diseases are highly seasonal. Some, like the flu, peak in winter. But heat and humidity increase the risk of certain infections caused by bacterial, viral and fungal pathogens.

For example, warmer weather and higher humidity can increase the survival of bacteria, such as Salmonella, on foods, which increases the risk of food poisoning.

Hot weather can also increase the risk of ear infections. Children may be at greater risk during hot weather because they often swim or play at the beach or pool. Water can stay in the ear after swimming and a moist environment in the ear canal can cause growth of pathogens leading to ear infections.

Which children are most vulnerable?

During heatwaves, we found infants aged under one were at increased risk of ED visits and hospital admission for any reason compared to older children. This is not surprising, because babies can’t regulate their body temperature effectively and are reliant on their caregivers to keep them cool.

Our study also found children from the most disadvantaged areas were more vulnerable to heat-related illness on heatwave days. Although we don’t know exactly why, we hypothesised families from poorer areas might have limited access to air-conditioning and could be more likely to live in hotter neighbourhoods.

Keeping kids cool: tips for parents

The highest levels of heat exposure on hot days for young children is usually when they’re taken outside in prams and strollers. To protect their children from direct sunlight, parents often instinctively cover their stroller with a cloth such as a muslin.

However, a recent study from our group showed this actually increases temperatures inside a stroller to as much as 3–4˚C higher than outside.

But if the cloth is wet with water, and a small fan is used to circulate the air close to the child, stroller temperatures can be 4–5˚C lower than outside. Wetting the cloth every 15–20 minutes (for example, with a spray bottle) maintains the cooling effect.

When young children are not in a stroller, and for older children, there are a few things to consider to keep them cool and safe.

Remember temperatures reported on weather forecasts are measured in the shade, and temperatures in the sun can be up to 15˚C higher. So sticking to the shade as much as possible is important.

Exercise generates heat inside the body, so activities should be shortened, or rescheduled to cooler times of the day.

Sunscreen and hats are important when outdoors, but neither are especially effective for keeping cool. Spraying water on the child’s skin – not just the face but arms, legs and even the torso if possible – can help. Wetting their hats is another idea.

Proper hydration on hot days is also essential. Regular water breaks, including offering water before, during and after activity, is important. Offering foods with high water content such as watermelon and orange can help with hydration too.

Wen-Qiang He, Research Fellow in Biostatistics and Epidemiology, Faculty of Medicine and Health, University of Sydney; James Smallcombe, Post-doctoral Research Associate, Faculty of Medicine and Health, University of Sydney; Natasha Nassar, Professor of Paediatric and Perinatal Epidemiology and Chair in Translational Childhood Medicine, University of Sydney, and Ollie Jay, Professor of Heat & Health; Director of Heat & Health Research Incubator; Director of Thermal Ergonomics Laboratory, University of Sydney

This article is republished from The Conversation under a Creative Commons license. Read the original article.