Heartburn drugs, also known as proton pump inhibitors, may be linked to an increased risk for dementia, according to researchers in Germany.
The study, published February 15 in the journal JAMA Neurology, did not solidly prove that taking PPI drugs caused brain disorders, but it showed a statistical association between heartburn drugs and dementia in elderly patients, said Britta Haenisch of the German Center for Neurodegenerative Diseases. Medical data of more than 73,000 patients aged 75 and older obtained from records between 2004 and 2011 were analyzed for the study.
Within the data, the researchers found 2,950 patients who received at least one prescription for heartburn drugs every four or five months over an 18-month period. The drugs included lansoprazole (Prevacid), esomeprazole (Nexium), and omeprazole (Prilosec), all made by AstraZeneca.
“In our analysis we focused on long-term regular PPI prescription for at least 18 months,” wrote Haenisch in an email.
Approximately 29,510 people developed dementia during the study period. The scientists found that repeated heartburn drug users were 44 percent more likely to develop a brain disorder.
There may be an association between heartburn drugs and a vitamin B12 deficiency, which could accelerate cognitive destruction. Also, the medication may be crossing the blood-brain barrier and interacting with brain enzymes associated with Alzheimer’s disease, says Haenisch.
“PPIs used for the treatment of gastroesophageal redux disease and peptic ulcers work by reduction of gastric acid production. The underlying mechanism by which PPIs might influence cognition is yet to be determined. To evaluate cause and effect relationships between long-term PPI use and possible effects on cognition in the elderly randomized, prospective clinical trials are needed.”
However, there is no way of knowing if PPIs and dementia are connected, as some of the patients may have already been predisposed to developing brain disorders.
While the link between heartburn drugs and dementia is inconclusive, one expert on aging, Dr. Malaz Boustani, is taking the study results very seriously.
The doctor noted that previous studies have linked a different type of antacid, known as H2 blockers, to a higher risk for dementia. He normally recommends that patients use PPIs to treat heartburn but now will share the results of the German study and let the patients decide.
“I’m going to disclose the finding to my patients and then let them decide whether they will take the risk or not,” said Boustani, a professor of medicine at the Indiana University Center for Aging Research.
Dr. Lewis H. Kuller of the University of Pittsburgh believes that heartburn drug use and dementia may be swayed by the same risk factors. According to Kuller, women who take PPIs are more likely to be obese, have arthritis, and typically have poorer health than others.
PPI drugs, which are used to treat gastric reflux or peptic ulcers, work by reducing the levels of acid manufactured by the stomach. Kuller added that heartburn drugs can also cause kidney disease, fracture, low magnesium levels, gastrointestinal infections, Clostridium difficile infection, and pneumonia.
According to 13 WMAZ News, roughly 15 million Americans spent over $10 billion on heartburn drugs in 2013. Many PPIs like Prilosec, Prevacid, and Zegerid, are available without a prescription, which leads to a higher use of the medication.
Some health experts are concerned that PPI drugs are being overused to treat very minor heartburn symptoms. According to Boustani, many people could easily find relief just by making simple changes to their diets such as eating smaller meals or avoiding chocolate and caffeine.
The director of geriatric education at North Shore-LIJ Health System in New York says the research doesn’t affirmatively show how heartburn medication would affect the brain. He says until there is enough evidence to indicate a relationship, there is no reason yet to be concerned.
While the study did not directly link heartburn drugs and dementia, Haenisch emphasized that health care providers should be careful not to overprescribe PPIs. Another study revealed that nearly 70 percent of prescriptions were not even appropriate for the patient and 25 percent could stop taking the PPI drugs entirely without experiencing increased heartburn or acid reflux.
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