Research suggests the medication for stomach issues such as acid reflux could have a serious impact
Longer-term use of common drugs taken by millions could increase the risk for dementia, a study has suggested. The research showed the risk risis in patients who used the acid reflux medication which is available over the counter for 4.5 years or more.
The report in Neurology does not actually prove that cumulative PPI use causes dementia, rather that is suggests an association.
Gastroesophageal reflux disease or gastro-oesophageal reflux disease is a chronic upper gastrointestinal disease in which stomach content persistently and regularly flows up into the esophagus, resulting in symptoms and complications.
Proton Pump Inhibitors (PPIs) are medications that significantly reduce the amount of acid your stomach produces by blocking the “proton pumps” in the stomach lining that are responsible for acid secretion. This decreased stomach acid helps relieve symptoms like heartburn, indigestion, and acid regurgitation, and it promotes healing of stomach and esophageal damage caused by excessive acid. PPIs are used to treat acid reflux, stomach ulcers, and to protect the stomach from the effects of certain other medications, like anti-inflammatory drugs.
In the UK, proton pump inhibitors (PPIs) like Omeprazole, Lansoprazole, Pantoprazole, Rabeprazole, and Esomeprazole are used to reduce stomach acid and treat conditions such as heartburn and acid reflux.
Study author Kamakshi Lakshminarayan, MBBS, PhD, of the University of Minnesota School of Public Health in Minneapoli said: “Proton pump inhibitors are a useful tool to help control acid reflux, however, long-term use has been linked in previous studies to a higher risk of stroke, bone fractures and chronic kidney disease,” said “Still, some people take these drugs regularly, so we examined if they are linked to a higher risk of dementia. While we did not find a link with short-term use, we did find a higher risk of dementia associated with long-term use of these drugs.”
“Studies on the association between proton pump inhibitor (PPI) use and dementia report mixed results and do not examine the impact of cumulative PPI use,” the study team wrote. “We evaluated the associations between current and cumulative PPI use and risk of incident dementia in the Atherosclerosis Risk in Communities (ARIC) Study.”
But the medication has been previously linked to higher risk of stroke, broken bones and kidney disease. The American research team, whose findings were published in the journal Neurology, say the study does not prove that acid reflux drugs cause dementia – it only shows an association.
The analyses involved participants from a community-based cohort from the time of enrolment (1987-1989) through 2017. PPI use was assessed via visual medication inventory at clinic and reported annually in study phone calls.
The authors said: “The present study uses ARIC Visit 5 as baseline, since this was the first visit in which PPI use was common. PPI use was examined two ways: current use at Visit 5 and duration of use prior to Visit 5 (Visit 1 to 2011, exposure categories: 0 days, 1 day-2.8 years, 2.8-4.4 years, >4.4 years). The outcome was incident dementia after Visit 5.”
The study included more than 5,700 people, age 45 and older, who did not have dementia at the start of the study. The participants had an average age of 75. The research team determined if the participants took acid reflux drugs by reviewing their medications during study visits and during yearly phone calls.
Of the participants, 1,490 (26 per cent) had taken the drugs. They were then divided into four groups based on whether they had taken the drugs and for how long: people who didn’t take the drugs; those who took the drugs for up to 2.8 years; those who took them for 2.8 to 4.4 years; and people who took them for more than 4.4 years.
“There were 585 cases of incident dementia over median follow-up time,” the authors stated. The participants were then followed for an average of around 5.5 years. During that time, 585 (10 per cent) developed dementia. Of the 4,222 people who did not take the drugs, 415 people developed dementia, or 19 cases per 1,000 person-years.
Scientists found that people who take proton pump inhibitors, or PPIs, for four-and-a-half years or more were 33 per cent more likely to develop the debilitating condition.
Dr Lakshminarayan said: “More research is needed to confirm our findings and explore reasons for the possible link between long-term proton pump inhibitor use and a higher risk of dementia. While there are various ways to treat acid reflux, such as taking antacids, maintaining a healthy weight, and avoiding late meals and certain foods, different approaches may not work for everyone. It is important that people taking these medications speak with their doctor before making any changes, to discuss the best treatment for them, and because stopping these drugs abruptly may result in worse symptoms.”
A limitation of the study was that because participants were asked about medication use once yearly, their use between annual check-ins was estimated. The authors were also unable to assess whether participants took OTC acid-reflux drugs.
She added: “It is important that people taking these medications speak with their doctor before making any changes, to discuss the best treatment for them, and because stopping these drugs abruptly may result in worse symptoms.”