Proton pump inhibitor (PPI) medications intended to fight heartburn and gastroesophageal reflux suffered another setback today when study results were announced demonstrating a link between this class of drug and the incidence of dementia in elder patients. JAMA Neurology published the conclusions of a German study that examined the effect of PPI medication on 73,000 senior citizens aged 75 and older. While the study itself was unable to demonstrate a ‘smoking gun’ connecting the development of cognitive difficulties and the use of popular medicines sold under the trade names Nexium, Prevacid, and Prilosec, participants who did use PPIs were 44% more likely to suffer from dementia.
Dementia is but the latest strike against proton pump inhibitors, which regulate stomach acid production but which have also been associated with side effects ranging from heart disease, vitamin and mineral deficiencies in the body, and even kidney disease. Even worse: withdrawal from the drugs often leads to the intensification of the heartburn symptoms that PPIs were designed to alleviate.
According to NPR, 15 million Americans are currently using proton pump inhibitors, and despite this week’s damning dementia data, that’s unlikely to change. In the absence of a clear causative link between stomach acid medicines and a dementia diagnosis, it would be unusual for standard clinical practice concerning the prescription of PPIs – as well as the FDA’s approval of over-the-counter versions of these drugs – to reverse itself. The mechanism by which PPIs could impact cognitive function is not understood, and until evidence demonstrating that connection is found then a treatment shift is unlikely.
It’s important to keep in mind, however, that PPIs are far from the only medication available to treat acid reflux and heartburn. Given the new information and known side effects of proton pump inhibitors, alternatives to PPIs could become more appealing to those suffering from these diseases. Another crucial point: while the elderly are more susceptible to developing dementia in the first place (as pointed out in this editorial published alongside the study results), there’s no reason to expect that proton pump inhibitors would not show the same results when used by younger individuals. These factors are among the many issues surrounding PPIs that are causing medical professionals to encourage further study into this class of drugs.