Can you take a PPI forever?

DEAR DR. ROACH: You have written about

PPIs such as Prilosec, which I have successfully taken for over 10 years to fight a severe case of GERD with a small hiatal hernia.

However, what is your opinion on my longterm usage ( which has been a true lifesaver) and continuing it essentially forever? My gastro specialist seems to be of the “keep taking it” attitude because of its success, but aren’t there potential downsides, specifically to kidney function? Is switching to an H2 blocker like Pepcid or Tagamet any easier on the kidneys? -- K. J.

ANSWER: All medicines have side effects, and it is worthwhile to periodically examine the risks and benefits of taking a medication long term. You already know the benefit: a large improvement in your quality of life. Balanced against that are several potential risks.

The clearest risk is probably infection. Not being able to make stomach acid puts a person at risk for Clostridium difficile infection ( severe diarrhea) and other infections, perhaps including pneumonia. Malabsorption of nutrients, especially magnesium and vitamin B12, is so frequent that testing may be appropriate in people who take PPIs long- term. Calcium may also be affected, potentially increasing risk of osteoporosis. This also deserves screening in the appropriate people at risk.

The association between chronic kidney disease and long- term PPI use is controversial, and is probably small. Still, a periodic check of kidney function is wise. There is weak evidence for a small increase in dementia risk.

With all of these risks, my preference for patients on long- term PPI is to try taking them off the medicine slowly and replace it with an H2 blocker, just as you suggest. It is effective for many, but there are some people who really need a daily PPI in order to not have significant daily symptoms. It is up to the person, but the risk of serious side effects is small enough that the benefit outweighs it for most.

DEAR DR. ROACH: After my wife and I receive both shots of the COVID-19 vaccine can we resume our gym classes and return to restaurants? We are both in good health. She is 68 and I am 70. -- G.G.

ANSWER: Not immediately. The vaccine is given in two doses, three or four weeks apart, and maximum protection isn’t reached for two weeks or so after the second dose. Even then, the protection isn’t perfect: 94% to 95% according to the best studies for the currently available vaccines. Because there remains rampant transmission in all areas of the country, it is safest for you and your wife to continue to socially distance and wear masks. That’s particularly important for people at high risk of complications.

Secondly, although the vaccine is excellent at reducing risk of developing symptomatic COVID- 19 infection, it isn’t clear whether it stops asymptomatic infections. It is possible that vaccinated people may be temporarily infectious after being exposed, without ever knowing they might be spreading virus. Until it is known for sure that is not the case, it is safer for others if you and your wife, and all of us who have been vaccinated, continue to wear masks and socially distance.

It is disappointing that we cannot immediately return to our lives before the pandemic began, but the vaccine is only part of the solution. We cannot let up on the rest of the behaviors we need to continue to stop the pandemic.

Dr. Roach regrets that he is unable to answer individual letters, but will incorporate them in the column whenever possible. Readers may email questions to ToYourGoodHealth@med.cornell. edu or send mail to 628 Virginia Dr., Orlando, FL 32803.

UNITED NATIONS (AP) — Secretary-General Antonio Guterres made an urgent appeal Thursday for $5.5 billion to prevent a “catastrophe” for 34 million people in over three dozen countries who are just one step away from famine driven by conflict -- and the World Food Program chief warned that 270 million people are facing “a hunger crisis” this year.

Guterres told a high- level U.N. Security Council meeting organized by the U.S. that more than 88 million people were suffering from “acute hunger” at the end of 2020 due to conflict and instability -- a 20 percent increase in one year -- and “projections for 2021 point to a continuation of this frightening trend.”

World Food Program Executive Director David Beasley said leaders responded to his warning to the council a year ago that the world stood on the brink of the COVID- 19 pandemic and a hunger pandemic that could push the number of people “marching to the brink of starvation” from 135 million to 270 million and lead to “famines of biblical proportions” in over three dozen countries.

Unfortunately, Beasley said, “the concerns of 2020 are now a reality for 2021” because of new waves of COVID- 19 and economies not yet surging back to normal.

“So, today, I must warn you that we are once again sliding toward the brink of the abyss,” he said. “Now, 270 million people are facing a hunger crisis.”

Both Guterres and Beasley stressed that the hunger crisis and looming famines are primarily driven by conflict and are entirely preventable.

“Climate shocks and the COVID-19 pandemic are adding fuel to the flames,” the U.N. secretary-general said.

He warned that “without immediate action, millions of people will reach the brink of extreme hunger and death,” pointing to projections showing that hunger crises are “escalating and spreading across the Sahel and the Horn of Africa, and accelerating in South Sudan, Yemen and Afghanistan.”

In some countries, Guterres said, “famine is already here” and “people are dying from hunger and suffering critical rates of malnutrition.”

“Parts of Yemen, South Sudan and Burkina Faso are in the grip of famine or conditions akin to famine,” he said. “More than 150,000 people are at risk of starving.”

Five years of conflict in Yemen have displaced 4 million people and left many “facing a death sentence as widespread hunger stalks their nation,” Guterres said. “Around half of all children under five -- 2.3 million -- are projected to face acute malnutrition in 2021. Some 16 million people face food insecurity.”

WFP’s Beasley, who was in Yemen two days ago, called it “hell on earth in many places” and warned that “we are heading straight toward the biggest famine in modern history.”

At Al Sabeen children’s hospital, the best in the capital Sanaa, he said children were “skin and bones, and dying with entirely preventable or treatable illnesses.” The hospital has 25 beds and Beasley said he asked a doctor about children that were turned away. “She replied, `They go home to die.’”

Guterres and Beasley cited other countries with growing hunger.

The secretary- general said Congo, with ongoing conflicts in its mineral-rich east and elsewhere, “experienced the world’s largest food crisis last year, with nearly 21.8 million people facing acute hunger between July and December.”

Beasley, who visited Congo last week, said “this year it is set to become the world’s largest hunger emergency with 19.6 million people facing crisis, emergency or catastrophic levels of food insecurity, up from 15.6 million people a year ago.”

In Afghanistan, nearly 17 million people face a similar emergency, up from 13.9 million people, Beasley said. In Nigeria, there has been “a staggering increase” to 13 million people from 5 million people, and in Syria after 10 years of war “over 12 million people face crisis levels of food insecurity or worse

an all-time high and up from 9.3 million people.”

Ten years after South Sudan declared independence, Guterres said 60% of the population is increasingly hungry, with chronic sporadic violence, extreme weather and the economic impact of COVID-19 pushing more than 7 million people into acute food insecurity. Food prices are so high, he said, that “just one plate of rice and beans costs more than 180% of the average daily salary -- the equivalent of about $400 here in New York.”

Beasley, who visited Western Pibor in South Sudan in early February, said in recent days he heard that “mothers are resorting to feeding their children with the skin of dead animals or even mud,” calling the “famine-like conditions” desperate and and appealing for “urgent action.”.