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Antacids Are Best First Choice for Indigestion
Date:1/15/2009

Study finds they're a bit cheaper than more potent drugs like PPIs

THURSDAY, Jan. 15 (HealthDay News) -- Starting treatment for dyspepsia -- the medical name for indigestion -- with run-of-the-mill antacids, then moving up to more sophisticated drugs if needed, is slightly less costly than starting with the more powerful drugs, a new study says.

"Most patients with new-onset dyspepsia are treated with empirical proton pump inhibitor treatment [meaning that treatment decisions are based on observation more than testing] all over the world, [making] proton pump inhibitors one of the most prescribed drugs worldwide, with enormous cost for society," noted study senior author Dr. Robert Laheij, of the department of gastroenterology at Radboud University Nijmegen Medical Centre in the Netherlands.

But he added that, "overall, most patients with dyspepsia could and should be managed with antacids and H2 receptor antagonists instead of treatment with proton pump inhibitors. Treatment with proton pump inhibitors should be reserved for those not responding to antacids or H2 receptor antagonists."

Proton pump inhibitors include such brand-name drugs as Prilosec, Prevacid and Nexium.

But the cost difference noted in the study was "tiny," said Dr. Maria T. Abreu, a professor of medicine and chief of gastroenterology at the University of Miami Miller School of Medicine. And given that the effects were about the same, "this is nothing terribly exciting," she said. "A lot of people were going to get better no matter what you did."

The study findings were published in the Jan. 17 issue of the journal The Lancet.

Proton pump inhibitors, H2-receptor antagonists and regular old antacids can all treat indigestion in its various forms. But guidelines on how to use these drugs are inconsistent, the study authors said.

Complicating matters is the fact that there's no uniform definition fo
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