The Risks of Treatment and Non-Treatment
A popular class of reflux and heartburn medications once considered harmless, might raise a senior’s risk of dementia, a new study suggests. Called proton pump inhibitors, this group of drugs includes such common medications as Prilosec, Nexium, and Prevacid. PPIs work by lowering the amount of acid produced by the stomach and are the most potent inhibitors of acid secretion available.
The new study, authored by Willy Gomm, PhD and colleagues, from the German Center for Neurodegenerative Diseases, and published online in JAMA Neurology last week, is significant as PPIs are among the most frequently prescribed drugs with use increasing sharply, especially among the elderly.
The researchers analyzed data on 73,679 adults age 75 and older, including 2,950 who took PPIs to treat gastrointestinal problems such as reflux, heartburn, or peptic ulcers. All were free of dementia at the start of the study, but 29,510 received a dementia diagnosis in an eight-year period.
Those who regularly took one of several prescription PPIs were 44% more likely to have developed dementia than were those who did not take the heartburn drugs. Risk was slightly greater for men. Among the PPIs taken most often by study participants—omeprazole (Prilosec), pantoprazole (Protonix), and esomeprazole (Nexium)—risk was highest for Nexium.
PPIs appear to affect levels of amyloid beta and tau, which are proteins associated with Alzheimer’s disease according to the study. PPI use can also lead to vitamin B12 deficiency, which has been associated with cognitive decline.
Who Is at Risk?
More than 15 million Americans used prescription PPIs in 2013, at a total cost of more than $10 billion, according to a report by the IMS Institute for Healthcare Informatics. Of those approximately 15 million Americans at risk are older adults who take PPIs to quell heartburn or the effects of reflux disease. Available over-the-counter or by prescription, PPIs are generally well tolerated and carry minimal short-term side effects; however, the effect of long-term use is less clear.
The Study’s Caveats
The study suggests but does not prove that taking PPIs can cause dementia. The researchers’ analysis accounted for some but not all factors that may have contributed to the development of dementia such as diet and body weight. PPI data was based on prescriptions—whether study participants also used over-the-counter PPIs was not indicated.
To Treat or Not to Treat
With the concern that accompanies taking PPIs, you may consider whether or not you should treat your reflux or heartburn. You must first determine the severity of your condition. Serious reflux is a condition that should be treated. Without treatment, reflux can cause serious complications such as esophageal or laryngeal cancer. If you find that, on the other hand, you do not have severe reflux, you should try to avoid long-term use of these medications. It is important to therefore be tested to both avoid the consequences of leaving reflux untreated or the consequences of taking unnecessary medication. Accurate testing is the only way to determine the need and the amount of medication.
Expert Treatment at Chicago ENT
Chicago ENT is one of the few places in the Chicagoland offering simplified, accurate in-office testing for reflux. Chicago ENT physicians utilize the Restech pH measuring system, which accurately provides precise real-time diagnostic information confirming reflux disease and the severity of each individual case, thus supporting better treatment.
Traditionally considered difficult to test for and often involving hospitalization, many have been treated for reflux disease without confirmatory testing. Moreover, testing is not standard among doctors who do not use the Restech pH measuring system, and standard testing is critical for patients taking medication over time. Only consistent and accurate testing can determine the appropriate way to treat and the appropriate medication dosages for reflux disease.
Those who wish to ease off PPIs or treat their reflux in light of this research should speak to their doctors first but can take a number of steps to reduce excess acid. They can eat smaller meals, lay off chocolate and caffeine, and stay upright for a few hours following each meal.
If you are concerned you were not appropriately tested for your reflux or would like to inquire about our treatment options, please call the experts at Chicago ENT at (773) 296-5500.