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Key Takeaways
- A recent study suggests patients who use acid reflux medications for several years may have a higher risk of developing dementia.
- Experts say more research is needed to better understand the potential connection between long-term acid reflux drug usage and higher dementia risk.
- Patients currently using acid reflux medications should consult with their healthcare provider first before making any changes or discontinuations to their medication regimen.
Millions of Americans every year use a class of acid reflux medications known as proton pump inhibitors (PPI) to treat symptoms of heartburn, indigestion, and other related conditions. However, a new study suggests there may be a link between these medications and cognitive disorders like dementia.
The study, published in the journal Neurology this month, found patients who take certain prescription acid reflux medications for several years may have a higher risk of dementia compared to people who do not take these medications.
Experts say that’s not how most people should take acid reflux medications.
“PPIs are typically intended for short-term management of gastrointestinal symptoms. However, some individuals remain on PPIs for long periods, or use PPIs despite not having a documented gastrointestinal diagnosis,” Pamela Lutsey, PhD, MPH, study co-author and professor in the Division of Epidemiology & Community Health at the University of Minnesota, told Verywell in an email.
Lutsey said patients should review their medications and symptoms with a qualified medical professional, to make sure that their health conditions are being appropriately managed.
Here’s what else you need to know about the study and what to do if you are currently taking acid reflux medications, according to experts.
What Are Proton Pump Inhibitor Medications?
Proton pump inhibitors (PPI) are a class of medications that decrease the amount of acid secreted by the stomach. According to Brooks Cash, MD, chief of the Division of Gastroenterology, Hepatology, and Nutrition with McGovern Medical School at the University of Texas Health Science Center at Houston, they are most commonly used to treat conditions such as:
- Peptic ulcer disease
- Gastroesophageal reflux disease (GERD)
- Stomach ulcers
- Erosive esophagitis
These medications are used by millions of people, including those with heartburn, said Jessica Kalender-Rich, MD, a geriatric medicine physician at the University of Kansas Health System. These medications are available over-the-counter or can also be prescribed by a healthcare provider.
How Long Are PPI Medications Meant To Be Used For?
Over-the-counter heartburn medication is meant to be used for no longer than two weeks. However, some prescription heartburn medications are taken for up to 12 weeks. Examples of prescription PPIs include medications like AcipHex (rabeprazole) and Protonix (pantoprazole).
Patients should talk with their doctor about which medication is right for them, in addition to the frequency and duration of medication use.
Long-Term Acid Reflux Medication Use May Increase Dementia Risk by 33%
Lutsey and her colleagues analyzed healthcare data from 5,712 people with an average age of 75 years old who did not have dementia at the start of the study.
They only looked at prescription PPI medications and excluded all over-the-counter options for the study. “We looked at PPI medications as a class, not at individual medications,” Lutsey said.
After reviewing patient medication use during study visits and yearly phone calls, the researchers determined 26% (1,490) of the participants had taken PPIs.
The researchers then split the participants into four groups based on how long they had taken PPI medications. This included:
- Those who have not taken PPI medications
- Participants who took PPI medications for up to 2.8 years
- Participants who took PPI medications for 2.8 to 4.4 years
- Participants who took PPI medications for over 4.4 years
The researchers followed the participants for an average of 5.5 years. They found during this time, 10% (415) of the participants developed dementia, including 11.7% of people who took the medications and 9.8% of those who did not take them.
After adjusting for certain factors like age, sex, blood pressure, and diabetes, they also found participants who took PPIs for over 4.4 years were 33% more likely to develop dementia than those who did not take the medications at all.
However, they did not find a higher risk of dementia for people who took the drugs for less than 4.4 years, Lutsey said.
“We did not find a higher risk of dementia with shorter-term use,” she said. “It is important to note that this study did not prove that acid reflux drugs cause dementia; it only shows an association. It is possible that other factors explain the association we observed between PPIs and risk of dementia.”
Why Acid Reflux Drugs May Increase Dementia Risk
Experts say more studies are needed to understand the potential link between long-term use of PPI medications and dementia risk. But one potential explanation for this link is that prolonged PPI use may contribute to vitamin B12 deficiency, which in turn can be associated with cognitive decline, Lutsey said.
Another explanation for this potential connection is that use of these drugs chronically may result in changes in the way the body produces and metabolizes amyloid in the brain, leading to an increase in beta-amyloid levels, Jason Krellman, PhD, associate professor of neuropsychology at Columbia University Irving Medical Center, told Verywell.
“Amyloid is a protein that’s known to be abnormal in Alzheimer’s disease and in some other conditions that can cause dementia,” Krellman said.
Additionally, PPI use may result in changes to the gut microbiome that could impact cognitive health, Krellman said. These medications may also induce some kind of inflammation in the brain or even oxidative stress effects.
“An imbalance between free radicals and antioxidants in the gut could later affect brain health,” he added.
Despite these reasons, Kalender-Rich said there are conflicting studies on whether a link actually exists. Some experts have considered that changes in gastric acid from these medications may affect the absorption of certain nutrients.
“On the other hand, many people who take these medications regularly for symptom management also have risk factors for other conditions that increase the risk of dementia, such as obesity,” Kalender-Rich said. “In the end, we just don’t have enough information to say that PPI use leads to dementia.”
Other Risks of Acid Reflux Medications
Previous studies have shown that long-term use of PPIs could be linked to a higher risk of stroke, bone fractures, and kidney disease, Lutsey said.
Long-term PPI use has also been associated with gastrointestinal (GI) infections such as C. difficile and other bowel conditions, Kalender-Rich added.
“They also increase a person’s risk of not absorbing certain vitamins and minerals, including magnesium, B12, and iron,” Kalender-Rich said. “There are smaller risks of other diseases as well.”
However, it’s important to note that health risks may vary significantly based on individual patient characteristics and comorbidities, said Cash.
Limitations to Consider
The researchers and other experts not involved in the study note there are several limitations to the study. For instance, researchers could not record the type or doses of medication patients took between yearly check-ins, and patients may have provided less accurate self-reports.
Cash said other potential flaws of the study include that the researchers used different methods at different times to contact and interview patients, and to assess the degree and duration of PPI use. They did not adjust for other factors that could be associated with increased risk of dementia, like family history, alcohol, or drug use.
“The failure to measure and control for all of these issues, in addition to others, could produce misleading results,” Cash said. “I would recommend extreme caution in the interpretation of the current study’s results.”
What To Do If You Are Currently Taking Acid-Reflux Medications
If you are currently using PPI medications, you should not stop taking them suddenly without talking to your healthcare provider first, Kalender-Rich said.
“People who are taking PPIs should not stop taking them based on this study because we do not have evidence of an actual causation,” she added.
Suddenly stopping PPIs can lead to a rapid increase in acid in your stomach, which can be uncomfortable, Kalender-Rich said. Furthermore, people who have been on PPIs for a prolonged period and suddenly stopping use can result in a rebound of acid hypersecretion and worsening heartburn or GERD symptoms, Rich added.
“This typically will resolve, but for patients with a history of symptomatic GERD or erosive esophagitis the odds are that their chronic symptoms will recur and their quality of life will decrease.”
If you’re concerned about continuing PPI medication use, experts recommend talking with your healthcare provider before making any changes or discontinuations to their medication regimen.
You can also ask your provider about other alternatives to treat heartburn, acid reflux, and other related conditions. Depending on the reason for being on a PPI, there may be other options like H2 blockers or even the use of antacids, said Kalender-Rich.
“It is best to discuss stopping them with your doctor first and then developing a taper plan together to avoid symptoms,” Kalender-Rich said. “We should all be reviewing our medications with our physician on every visit, including our over-the-counter medications, to be sure that they are still needed and make sense. PPIs can be a part of this standard review.”
What This Means For You
Experts say patients who are currently taking acid reflux medications called proton pump inhibitors should not stop taking them based on the findings of this study. However, those who are concerned should talk with their healthcare provider first before making any changes to their medication regimen.
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Long-Term Use of Acid Reflux Drugs May Be Linked To a Higher Risk of Dementia - Verywell Health
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