Acid reflux sufferers, listen up!
According to a recent study, researchers have found a link between elevated risk of dementia and long-term use of certain prescription acid reflux medications.
Acid reflux happens when a muscle in the lower end of the esophagus relaxes at the wrong time and allows stomach acid to back up into the esophagus. When this occurs frequently, gastroesophageal reflux disease (GERD) can develop, leading to esophageal cancer.
Presently, proton pump inhibitors (PPIs) are the primary therapy for GERD and are only recommended for short-term use of 4-8 weeks. But, studies have shown that chronic PPI use is linked to health conditions, including stroke, cardiovascular disease, and chronic kidney disease. While studies indicate that PPI use increases dementia risk, other research suggests it does not.
Confused?
Obviously, more research is needed.
Understanding more about how the use of PPIs affects dementia risk could inform health recommendations and treatment plans.
Recently, researchers investigated the link between PPIs and dementia incidence. They found that people who took the drugs for more than 4.4 years had a higher incidence of dementia than those who did not.
Dr. Jessica Kalender-Rich, a geriatric medicine specialist at the University of Kansas Health System, not involved in the study, said,
“This study supports the need for further investigation for a biochemical cause of cognitive impairment related to taking PPIs. However, there are sometimes very important medical reasons to take these medications so it is important to ask your prescriber before making changes.”
The study was published in Neurology.
So, what’s the link between acid reflux drugs and dementia risk?
Researchers only looked at prescription medications and excluded over-the-counter medications for the study. They analyzed healthcare data from 5,712 people with an average age of 75.
The use of PPIs was determined by reviewing medications during study visits and yearly phone calls. Altogether, 26% of the participants, or 1,490 people, had taken PPIs.
They were split into four groups according to how long they had taken the medications. They included:
- not having taken the drugs
- taking the drugs for up to 2.8 years
- taking the drugs for 2.8 to 4.4 years
- taking the drugs for over 4.4 years
The participants were tracked for an average of 5.5 years. During this time, 10% of the participants developed dementia, including 9.8% of people who did not take the medications and 11.7% of those who did.
After adjusting for factors including age, sex, and health-related factors such as high blood pressure and diabetes, the researchers found that those taking PPIs for over 4.4 years were 33% more likely to develop dementia than those who did not take the medications.
They also reported that those who took the drugs for less than 4.4 years did not have a higher incidence of dementia.
Dr. Kalender-Rich noted that how exactly chronic PPI use is linked to increased dementia risk is unknown.
“It is [also] difficult to tell at this point if the patients taking PPIs are already at higher risk of dementia due to other comorbidities that lead to the need for PPI or if there is actually a direct link to dementia,” she added.
Dr. Jason Krellman, PhD., associate professor of neuropsychology at Columbia University Irving Medical Center, said that chronic use of the drugs might lead to vitamin B12 deficiency or changes in how the body produces and metabolizes amyloid, a protein known to fold abnormally in Alzheimer’s disease and related conditions that cause dementia.
“These drugs are known to elevate stroke and kidney disease risk, and those conditions raise risk of dementia,” he explained, “We are just beginning to understand the relation between microscopic biological processes in the gastrointestinal tract and in the brain, and these drugs must induce inflammation or imbalance of free radicals and antioxidants in the gut that later negatively affect brain health.”
Dr. Krellman identified several limitations to the study.
He said the researchers couldn’t record the type or doses of medication patients took between yearly check-ins, noting that patients with dementia may have provided less accurate self-reports.
“[Additionally, while] the researchers looked at some common drug combinations that people took, [they couldn’t investigate] less common combinations that might elevate dementia risk, or even explain some of the risk from taking PPIs that the researchers reported,” he added.
Ultimately, he stated that the study did not show that PPIs cause dementia, “This study only showed an association between elevated risk of dementia and taking these medications for four and half years or more in a sample of adults 45 and older.”
He went on to say,
“We need to commission studies to look at the reasons for this drug-dementia link so that providers and patients can make more informed choices about whether taking these drugs carries more risk than benefits for each person.”
He added that the study highlights that some medications can harm long-term health outcomes. And that providers and patients should consider lifestyle changes, such as diet or weight loss, to ease their symptoms before starting medications.
“However,” he concluded, “most older adults do not develop the disabling cognitive changes that define dementia, and this study showed only a modestly elevated risk from taking PPIs. If you’re an older adult, the odds of avoiding dementia are still on your side, especially if you live a heart- and brain-healthy lifestyle.”
Sources:
https://www.webmd.com/heartburn-gerd/what-is-acid-reflux-disease
https://www.mayoclinic.org/diseases-conditions/gerd/symptoms-causes/syc-20361940
https://www.cancer.gov/types/esophageal/patient/esophageal-treatment-pdq
https://www.drugs.com/drug-class/proton-pump-inhibitors.html
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6463334/
https://pubmed.ncbi.nlm.nih.gov/31895707/