Studies linking PPIs to dementia are no need for panic

Proton pump inhibitors (PPIs) were first approved for use in the 1980s. They are sold by prescription and over-the-counter under a variety of brand names, including Nexium, Prilosec and Prevacid. By lowering the amount of acid produced in the stomach, these medications are very effective at treating heartburn and indigestion, along with additional diseases such as peptic ulcers and H. pylori bacterial infections. They also are important for use in patients with Barrett’s esophagus.

Chances are you have heard or read in the news about recent studies that suggest PPIs may cause an increased risk of dementia in older adults. An estimated 15 million Americans currently use PPIs to treat heartburn, so this news is relevant to many people.

If you are one of those individuals, please know there is no need to panic. This research is in the very early stages and did not take into account factors such as diet, lifestyle, education and other medications taken, all of which could have had an impact with onset of dementia. It is therefore far too soon to start making wholesale changes with the way we use and prescribe PPIs.

I agree with the comments made by Kenneth R. DeVault, MD, FACG, who serves as president of the American College of Gastroenterology:

We appreciate and respect the data in the study, but believe more research is needed to understand the impact of PPIs on cognitive function, especially since studies of this type do not control for diet or lifestyle factors, nor do they establish causation.

It is important for patients to follow package instructions on over-the-counter PPIs. If a patient has been treated for a long period of time, they should talk to their health care provider before stopping or changing the dose of these medications. Those with serious esophageal disorders should consult with a gastroenterologist before stopping the medication or changing the dose.

As a clinician, I will continue to use lifestyle and dietary changes as a first line of treatment. However, I also recognize that for some patients those changes are not enough. In those cases, I have no qualms about continuing to prescribe PPIs.  It is very clear that PPIs still play a critical role in controlling many diseases of the upper gastrointestinal tract.

All medications come with risks and benefits. Physicians have a duty to follow guidelines for prescribing medications and to provide patients with all the information they need to make a well-informed decision about whether or not taking a certain medication is right for them.

Also, all medications – whether prescription or over-the-counter – should be taken according to directions provided by the manufacturer.

If you are currently taking PPIs and have concerns about possible long-term effects, schedule an appointment with your physician to discuss possible alternative treatment methods and the best course of action for you.

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