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The Inside Tract

Proton Pump Inhibitors and Dementia…Is it Real?

Many of you have undoubtedly seen news articles referencing a German study that was recently published in JAMA Neurology (JAMA Neurol. Published online February 15, 2016.jamaneurol.2015.4791) that describes an association of proton pump Inhibitors with an increased risk of dementia. Many news outlets have jumped on this and reported it as an absolute cause and effect, in other words stating that if you use long term PPI therapy you will have a 44% increase in your chances of developing dementia. Fortunately, it is not that simple.

Pay close attention to the title and the word association. An association does not by any means say that the drugs cause dementia. The only way to make this determination is in a very controlled, randomized trial where you take well matched groups (ages, comorbid conditions, use of other medications, weight/diet, etc.) and study one on PPI therapy and the other on placebo. Their study was a retrospective look at medical records, not individual patients. These patients were all over the age of 75. They had a wide variety of comorbid conditions that could have played into the outcome. A real world example is that we often see dementia from small vessel disease in the elderly. This finding prompts the use of blood thinners. The drugs are associated with an increased risk of GI bleeding from a variety of sources. GI bleeding, or the risk thereof, often leads to prescribing PPI therapy to diminish the risks of bleeding. Hence you could then make the association of dementia with PPI therapy. This is easily made, but unfounded, leap of faith.

I am not saying that this association isn’t going to eventually lead to the research showing that there is a real concern with development of dementia in PPI users, it is just too early to get worried and abruptly alter PPI use. As with all drugs, we really need to weigh the pros and cons of long term use. PPI therapy isn’t as risk free as we originally thought. There is well defined increases in bone loss, vitamin malabsorption (Vitamin D, B12, etc.) and an increased risk of C Difficile infection. However, these drugs have made an amazing impact on the countless individuals who suffer with unrelenting chronic acid reflux, which in and of itself can lead to one of the fastest rising types of cancer, esophageal adenocarcinoma associated with Barrett’s esophagus not to mention a multitude of respiratory issues.

My bottom line…give it time to be looked at more closely before stopping your medication. Talk with your physician, weigh the pros and cons of continued therapy vs endoscopic therapy (Stretta) or traditional surgical fundoplication, and look to future placebo controlled studies.

- Dr. Arterburn

Study examines effect of PPI exposure on blood vessel cells

A study in the journal Circulation Research found that long-term exposure to proton pump inhibitors led to faster aging of endothelial cells by impairing the ability of the cells’ lysosomes to produce enough acid to clear waste. Researchers suggest that this aging effect might hamper the cells’ ability to protect blood vessels and prevent heart attack and stroke, which could explain the association between PPI use and elevated heart disease risk.

HealthDay News (5/10)