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POLYCYSTIC LIVER DISEASE – PROTON PUMP INHIBITORS
	POLYCYSTIC LIVER DISEASE PROTON PUMP INHIBITORS are prescribed for reflux and GERD. An added theoretical benefit is that it diminishes secretin, a hormone that triggers cyclic AMP release triggering livers cysts to fill with fluid, grow, expand and enlarge. Recently a study has shown that proton pump inhibitors can increase the risk of hip fractures due to diminished calcium absorption.

Proton pump inhibitors and H2 blockers WARNING EMAIL

A recent study looking at the effects of proton pump inhibitors increasing hip fractures. The study included 13,556 hip fractures and 135,386 controls from the United Kingdom. The researchers looked only at patients ages 50 and older who used acid suppression drugs and controls were matched for sex, age, duration of follow-up. A similar analysis was done for histamine 2 receptor antagonists, which have a weaker acid suppressive effect compared with proton pump inhibitors and do not interfere with osteoclastic proton pumps to reduce bone resorption. Histamine 2 receptor antagonist used for more than one year was also associated with an increase in hip fractures, but a lower risk than proton pump inhibitors. WARNING

What starts these flat sacs to fill with fluid?
Liver cysts begin as flattened tiny microscopic sacs at the end of liver ducts. These flat sacs become like little tiny blind sacs that go nowhere. They connect with nothing. Eventually the tiny sacs break off and form very flat microscopic circular pads. Eventually these flat pads fill with fluid and form very small tiny microscopic liver cysts.

When a meal with protein is eaten, the stomach starts to produce acids to digest the meal. These acids eventually turn the stomach contents to acid chyme. Once the pH of the stomach contents becomes acid, this stimulates secretin hormone to be released. Secretin communicates with another hormone called cyclic AMP which surrounds these flattened circular pads within the liver. Once cyclic AMP is informed by secretin release, it begins the process of filling these little sacs with fluid. They start oozing fluid from the inside walls. This creates a water filled cyst.

Over time, years, this process continues until sometime we notice that we get bloated very quickly following a meal. The water within the cysts has nowhere to go. It creates a belly filled with water balloons. These cysts weigh upwards of 40 pounds. We think we are gaining weight when we are actually losing body fat and becoming very thin and malnourished.

Proton pump inhibitors diminishes acid chyme in the stomach. This stops secretin release and this eliminates the trigger for cyclic AMP release and this stops liver cysts (PLD) from filling with fluid, expanding and growing, increasing their numbers and size.

This is the theory. The French experience corresponds with this as well as my own personal experience. Following a liver resection the liver drains copious amounts of cyst fluid from the liver cysts which have been opened. The French found that by giving H2 blockers or proton pump inhibitors the draining fluid diminished. A few individuals have noted that while taking proton pump inhibitors or H2 blockers, their liver cysts have stabilized and a few have observed that they have decreased. WARNING A recent study has shown there is an increase in hip fractures in the over 50 crowd with long term use of proton pump inhibitors. Proton pump inhibitors interfere with osteoclastic proton pumps and reduce bone resorption.

What are some common proton pump inhibitors?
Proton Pump Inhibitors - for reflux and GERD
Lansoprazole -Prevacid
Omeprazole -Prilosec
Esomeprazole - Nexium
Rabeprazole - Aciphex
Pantoprazole - Protonix
Oral pantoprazole is indicated for short-term (up to 8 weeks) treatment in the healing and symptomatic relief of erosive esophagitis associated with gastroesophageal reflux disease (GERD). Some common drugs in this class are: lansoprazole (Prevacid - the preferred drug with the least drug interactions), omeprazole (Prilosec) , pantoprazole (Protonix), esomeprazole (Nexium). These impede acid production by blocking the actions of histamine, a substance produced by the body that encourages acid secretion in the stomach. Acid chyme from a high protein meal triggers the outpouring of secretin. Secretin stimulates cyclic AMP. This causes liver cysts to expand and fill with fluid. This is why so many with multiple liver cysts have noted that following a meal they have to almost bend over backwards to make room for the food. The main complaint is of extreme discomfort and bloating. We are so uncomfortable that eating becomes difficult. Eventually I could only eat a half cup of food before the expansion of the liver would just pop it back up and out of my mouth.

What are some common histamine-2 Receptor Blockers?
Histamine-2 Receptor Blockers - Some are currently available over the counter in the US
Cimetidine (Tagamet, Tagamet HB)
Famotidine (Pepcid AC, Pepcid Oral)
Famotidine Oral Suspension (Pepcid Oral Suspension)
Nizatidine capsules (Axid AR, Axid Capsules, Nizatadine Capsules)
Ranitidine (Zantac, Zantac 75)
Ranitidine Effervescent Tablets or Granules (Zantac EFFERdose)
Ranitidine Hydrochloride Injection (Zantac Injection)
Ranitidine Oral Syrup (Zantac Syrup)

• Cimetidine (Tagamet) has few side effects; approximately 1% of people taking cimetidine will experience mild temporary diarrhea, dizziness, rash, or headache. Cimetidine interacts with a number of commonly used medications, such as phenytoin, theophylline, and warfarin. Long-term use of excessive doses (more than 3 g per day) may cause impotence or breast enlargement in men; these problems resolve after the drug is discontinued.
• Famotidine (Pepcid AC) is the most potent H2 blocker. The most common side effect of famotidine is headache, which occurs in 4.7% of people who take it. Famotidine is virtually free of drug interactions but the FDA has just issued a warning on its use in patients with kidney problems.
• Ranitidine (Zantac) interacts with very few drugs. In one study, ranitidine provided more pain relief and healed ulcers more quickly than cimetidine in people younger than 60, but there was no difference in older patients. A common side effect ranitidine is headache, which occurs in about 3% of the people who take it.
• Nizatidine (Axid) is a new H2 blocker. It is nearly free of side effects and drug interactions.
Long-Term Concerns. In most cases, H2 blockers have good safety profiles and few side effects. These agents can interact with other drugs, although some less so than other. In all cases, however, the physician should be made aware of any other drugs a patient is taking. There are also some concerns about possible long-term effects.

• Liver damage. (This is more likely with ranitidine than other H2 blockers, but is rare in any event.)
• Kidney-related complications. Adverse effects on the central nervous system in patients with even moderate renal (kidney) insufficiency have been reported with famotidine and may result in anxiety, depression, and mental disturbances.
• Increased risk for pneumonia in hospitalized patients.

FDA Warning for Famotidine (Pepcid AC)
Famotidine is excreted primarily by the kidney. This can pose a danger to people with kidney problems. Physicians are now being advised by the US Food and Drug Administration and Health Canada to reduce the dose and increase the time between doses in patients with kidney failure. Use of the drug in those with impaired kidney function can affect the central nervous system and may result in anxiety, depression, insomnia or drowsiness, and mental disturbances.
Warning both Histamine-2 blockers and Proton Pump Inhibitors have been associated with an increase in hip fractures. To read more about the two class of drugs compared and the OTC vs prescription forms click here and the UK study click here.

FREQUENTLY ASKED QUESTIONS
Regarding Protonix and cyst reduction, can you provide me with any studies on this?

There were (2) studies. One done by the French following liver resection surgery and a second by a doctor who placed tiny catheters in liver cysts and noted that they enlarged and began filling with fluid in response to secretin. I spoke with a liver cyst researcher at the Mayo. She told me that liver cysts have 10 - 100 times the amount of cyclic AMP in their cells as do kidney cysts. What this means is for us with liver cysts we should really stay away from caffeine and even de-caf foods, beverages, and herbs. Chocolate is a really difficult one for me, personally. It has long been established that caffeine stimulates cyclic AMP increases which stimulates all cyst growth, not only liver and kidney. The danger of cyst growth is that internally cyst liquid produces an inflammation of the normal tissue of the organ with subsequent scar formation. It is the scar formation which creates most of the difficulties and symptoms.

ARTICLES PLD - LIVER CYSTS
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PLD gene for ADPLD
PLD lecture 2004 Dr Torres
PLD researcher Dr. Somlo
PLD lecture part one Dr. Perrone 2001
PLD lecture part two Dr. Perrone 2001
PLD treatment hepatic artery ablation
PLD treatment liver resection
PLD treatment liver resection when symptomatic
PLD treatment Mini invasive approach
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PLD treatment liver resection treatment of choice
PLD treatment liver resection Alberta hospital
PLD treatment liver resection Mayo Dr. Nagorney
PLD treatment liver resection 1995 Dr. Nagorney
PLD treatment liver resection insurance helpful
PLD treatment liver resection Netherlands experience
PLD treatment Netherlands experience
PLD Transplant Liver Jacksonville 1000th transplant
PLD Transplant Liver transplants over 70
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PLD Transplant Anti-viral CMV prior to transplant
PLD Transplant USC world's first bloodless transplant
PLD Transplant guidelines living donor transplant
PLD Transplant LA Mom dual transplant children
PLD Transplant A bloodless Coup
PLD Transplant After two organ transplants robotics
PLD Transplant Helpful insurance
PLD Transplant Traded 46 pound cystic liver
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PLD Herbs Milk Thistle useful
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PLD Herb avoid Maca contains hormones
PLD Herb Sprouts DIMs broccoli sprouts
PLD Herb Artichoke liver protector
PLD Herb Saffron liver
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PLD Help Tests - Interpreting Liver detox profile
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PLD Decline 7% Breast Cancer with less HRT
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PLD Help Proton Pump Inhibitors risk hip fractures
PLD Help H2 Blockers differences
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PLD Somatostatin Liver ascites
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PLD Octreotide research update on pages 18-19
PLD Prescribing information Long Acting
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PLD Octreotide long acting form - more information.
PLD Somatostatin Octreotide used in Acromegaly.
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PAIN RELIEF
Pain Laparoscopic denervation by J F Valente MD
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RESEARCH CLINICAL TRIALS
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Research Octreotide Sandostatin PKD clinical trial
Research Octreotide Sandostatin long acting
Research Somatostatin short acting IV
Research Somatostatin Octreotide Sandostatin LAR
Research Somatostatin Grantham MD
Research Somatostatin Acromegaly

LISTEN TO LECTURES
PLD POLYCYSTIC LIVER by Dr. V. Torres listen to this exceptional taped lecture on PLD.