You may have heard about a recent study linking antacid use to dementia, but a gastroenterologist in Northern Virginia is telling people not to lose their perspective.
PPIs are proton pump inhibitors, a form of antacid commonly used for gastroesophageal reflux disease and peptic ulcer disease. Some of the common brand names for PPIs include Prevacid, Nexium, and Prilosec.
Earlier this month, a new study in the Journal of Neurology followed more than 5,000 people ages 45 and older who were on proton pump inhibitors for five years, and found a 33 percent increased risk of dementia in patients who were on the drugs for more than 4.4 years.
Dr. Alexander Jow, the assistant chief of gastroenterology in Northern Virginia for Kaiser Permanente, says he was bombarded with messages earlier this month “of just like, ‘I’m on PPIs; I don’t want to be them anymore,’ or, ‘Is this true? Am I going to have dementia?’”
About the Study
“This is not a new concept,” says Jow, who is careful to call the results of the study “a link” and not “an association,” and says there are several reasons not to take drastic measures.
Jow emphasizes that this was an “observational” study. “There are a lot of confounding variables that are in it,” he says. “There is sometimes bias in the study. So a lot of times these are not considered very conclusive or high quality studies.”
For example, he says, another observational study in the journal Gastroenterology a few months ago looked at the same question and found “that there was no association of PPIs and dementia,” Jow says. “So again, I think you want to take these studies and the results with a grain of salt. What you should know about this is that there may be an association, but association does not necessarily mean causality.”
The study that’s received all the attention has a few theories about what might be causing the link, but no real evidence to bear them out, such as the fact that PPIs decrease absorption of vitamin B12, and a B12 deficiency can be associated with dementia. Another study on mice has found that PPIs may impair amyloid metabolism, thus leading to beta amyloid levels in the brain, which have been associated with Alzheimer’s disease and dementia, Jow says.
Jow listed some other possible explanations: “People who are on PPIs often are on a lot of other medications. So PPIs can be a marker of polypharmacy, which we know is associated with dementia; patients who are on PPIs more often have other medical issues like hypertension, hyperlipidemia; they may be overweight or have a poor diet. And those are all risk factors for dementia as well.”
He adds, “I think there isn’t any kind of smoking gun.”
What to Do
The American Gastroenterological Association replied to the study with a statement “trying to reassure patients that generally, you can continue the use of PPIs as medically indicated. So right now, at least, our society is not necessarily saying ‘Everybody stop their medications,’” Jow says.
All that said, if you’ve been prescribed for a long time, it’s always worth talking with your doctor about what’s going on, Jow says.
The link, he reiterates, was found among patients who had been on the PPIs for more than 4.4 years. He added that it’s worth reviewing with your doctor why exactly you’re on the PPIs. Jow says a different study found that up to two-thirds of people on long-term PPIs don’t have a clear indication.
“So they’re kind of put on these medications, but never have that follow-up discussion with their physicians about whether you do need to be on this long-term, or whether we should de-escalate dosing,” Jow says.
PPIs are beneficial when treating some conditions, even long-term, the benefits can outweigh the risks, “But for your basic GERD, a lot of times the first therapy is PPIs. But generally it’s recommended for four to eight weeks; it’s not an indefinite therapy,” Jow says. You need to make lifestyle changes, such as losing weight and avoiding tobacco and alcohol, along with taking the PPIs, so that you don’t need to be on them in the long term, he adds.
It’s also worth remembering that there’s another whole class of antacids known as histamine receptor antagonists, sold under brand names such as Pepcid, Zantac, and Tagamet, which haven’t been associated with any dementia risk. “So again, having that discussion of, ‘OK, I need medications for acid reflux, but which ones may be safer?’ It would be an appropriate discussion as well.”
Feature image, stock.adobe.com
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