Proton Pump Inhibitors and Dementia

Dr. Harish Gagneja, an expert in proton pump inhibitors.

A recent study published by the journal Neurology suggests a link between proton pump inhibitors and dementia. Dr. Harish Gagneja, Chief Medical Officer for Austin Gastroenterology, weighs in:

Proton pump inhibitors (PPIs) are a class of medications commonly used to treat conditions related to excess stomach acid production. They work by reducing the production of stomach acid, which can help alleviate symptoms and promote healing in conditions where excessive acid is problematic. Because of PPIs there is reduction in peptic ulcer disease as well as esophageal inflammation and narrowing resulting in significant reduction in gastric surgeries and improved quality of life for these patients.

Bad Press and Concerns

Despite their benefits, PPIs have faced some negative publicity and concerns over their long-term use. These issues are overblown and based on poorly executed studies. Population-based retrospective chart analyses are the studies which rank lowest on the totem pole. These studies have never proven causation with anyone of the concerns raised with PPIs.

One such study was recently published in the Journal Neurology linking dementia to the PPIs. This was picked up by the national news agencies and was all over media today in spite of very poor evidence (if any) based on this poorly done study. Here are the issues with the study:

  1. This study doesn’t prove causation only association that too is very weak. It is a population-based study and hence very low-quality study. Study’s own conclusion states “we found a positive but non-significant association between current use of PPI and risk of dementia over 5.5 years of follow-up.”
  2. Participants were called annually (only once) whether they use PPIs or not. This doesn’t prove PPI use of the year.
  3. There is no mention of over the counter PPIs for control group participants.
  4. We can’t extrapolate the findings to general population as only white and African American patients included.
  5. If information of diabetes, body mass index and hypertension was missing, subject was not included in the study which induces bias as these are well known risk factors for dementia.
  6. A very well randomized controlled trial published in JAMA (highest quality trial) showed no difference at 4 years follow up.
  7. There is no difference at 4.4 years but there is a difference at 4.5 years, what is so magical about the additional month.

It is unfortunate that these kind of poorly done studies are accepted for publication in the journals and gives media fodder to sensationalize the medical news which has no value to the public. Media is concerned with only two things: eyes and clicks. Shame on our media to give the poorly baked story to the public for consumption which can adversely affect their health.

It is to be noted that only 5% of the medical literature changes medical practice and rest is used to gain promotions.

For Patients

It is highly advisable to discuss your individual situation and concerns with a healthcare professional to make an informed decision about medications.