Popular Heartburn Medicine May Increase Dementia Risk By 33%
Many people reach for heartburn medication when they experience acid reflux, a condition that occurs when stomach acid flows into the esophagus. While acid reflux medication may provide relief for the short term, new research suggests that people who take these drugs over several years may be at risk for developing dementia.
A study published in August in the journal Neurology focused on the possible dangers of prolonged use of proton pump inhibitors (PPIs), medications that reduce the amount of stomach acid made by glands in the lining of the stomach.
PPIs are used to treat symptoms of acid reflux, which some people have after eating a meal. PPIs also treat gastroesophageal reflux disease, a serious form of acid reflux in which food or liquid moves up from the stomach to the esophagus. Among the most well-known PPIs, also called “acid reflux drugs,” are sold under the brand names of Prevacid, Nexium, and Prilosec. PPIs are available over the counter and by prescription.
While PPIs are useful to help control acid reflux, previous studies have linked the long-term use of these medications to a higher risk of stroke, bone fractures, and chronic kidney disease, according to Dr. Kamakshi Lakshminarayan, a vascular neurologist and researcher at the University of Minnesota School of Public Health, and senior author of the new study.
“Still, some people take these drugs regularly, so we examined if they are linked to a higher risk of dementia,” Dr. Lakshminarayan, a member of the American Academy of Neurology, explained in a press release. “While we did not find a link with short-term use, we did find a higher risk of dementia associated with long-term use of these drugs.”
Dementia is a broad term used to describe changes in the brain that can impair memory, language, thinking skills, and personality. The changes, which happen over time, can be severe enough to interfere with daily living activities and independent function. Alzheimer’s disease accounts for 60-80 percent of dementia cases, according to the Alzheimer’s Association.
Details and Results of the Study
The University of Minnesota research team’s study involved 5,712 people ages 45 and over who did not have dementia at the beginning of the study. The average age of participants was 75. Team members interviewed study participants during in-person visits or once-a-year phone calls.
Of the total number of participants, nearly 1,490 people or 26 percent, had taken PPIs during that time. Those who were prescribed acid reflux drugs were placed in four groups based on how long they took the medications. The study did not include over-the-counter versions of PPIs.
Participants were followed for about 5.5 years, and during this time, 585 people, or 10 percent, developed dementia. Of the 497 people who took acid reflux medications for more than 4.4 years, 58 people developed dementia. Of the 4,222 people who did not take the drugs, 415 developed dementia.
After adjusting for factors such as age, sex, race, and health-related conditions, such as high blood pressure and diabetes, participants who took acid reflux drugs for more than 4.4 years had a 33 percent higher risk of developing dementia than people who never took the drugs, the study said. The research team did not find a higher risk for people who took PPIs for less than 4.4 years.
The Study’s Limitations
Dr. Lakshminarayan said the new study does not prove that acid reflux drugs cause dementia, it only shows an association. Therefore, more research is needed to confirm her team’s findings and explore reasons for the possible link between PPI use and a higher risk of dementia.
In addition, researchers noted that their study had some limitations. For one, participants were asked only once a year about their PPI use. So, if participants stopped using the medication and then started taking it again between check-ins, estimations could be inaccurate. What’s more, researchers said they only looked at prescription drugs since over-the-counter drugs were not included in the study.
Further, Dr. Lakshminarayan told CNN that because her team did not have data on vitamin B12 levels for study participants, they could not comment on studies showing the use of acid reflux drugs may be associated with low B12 levels. “And low B12 is associated with impaired thinking and poor memory,” Dr. Lakshminarayan said.
In addition to not including vitamin B12 deficiency, Dr. Fouad J. Moawad, a gastroenterologist and spokesman for the American Gastroenterological Association (AGA), told USA Today that the study did not measure factors such as depression, socioeconomic status, and H. pylori, a type of bacteria that can infect the stomach.
In a separate interview, Dr. Moawad, who was not involved in the new study, told US News & World Reports that studies published since 2016 that examine the association between PPIs and dementia have mixed conclusions. For example, some research found no association between PPIs and dementia, while some even linked PPIs to a decreased dementia risk.
“This can be confusing for both patients and prescribers,” Dr. Moawad said.
In 2022, the AGA updated its guidelines for doctors on when PPI prescriptions should be reduced or discontinued. For people who require PPIs to treat severe reflux esophagitis, Barrett’s ovaries, and peptic ulcers, Dr. Moawad advises taking the lowest effective dose. Additionally, Dr. Moawad recommends avoiding foods that can cause stomach acid, not eating within three hours prior to sleep, elevating your head when sleeping, and losing weight.
PPIs are “well-tolerated drugs and work well for acid-related disorders,” Moawad told USA Today. “With that said, PPIs are likely overprescribed. I often advise my patients to weigh the risks and benefits of any medical treatment.”
Dr. Lakshminarayan added that although there are various ways to treat acid reflux, such as taking antacids, maintaining a healthy weight, and avoiding late meals and certain foods, different approaches may not work for everyone.
“It is important that people taking these medications speak with their doctor before making any changes to discuss the best treatment for them, and because stopping these drugs abruptly may result in worse symptoms,” Dr. Lakshminarayan stated in a press release.