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New Research Shows Long-Term PPI Use Increases Risk of Dementia

PPI medicine pouring out of medicine bottle

Dr. Jacobs’ Key Points

  • GERD is serious and must be addressed through lifestyle change, medication, and/or surgical means before it progresses.
  • PPIs can be an appropriate but TEMPORARY intervention for chronic acid reflux, known as Gastroesophageal Reflux Disease / GERD.
  • PPI should not be taken for longer than six weeks, and their over-the-counter (OTC) status does not mean they are appropriate for long-term use.
  • We’ve got options beyond the traditional surgical fundoplication.
  • Research the LINX reflux management device – a 15-minute, highly effective surgery with minimal downtime.

Acid reflux is something that most Americans will experience at times over their life. For most, this transient issue can be well-managed with antacids like Tums. However, this acid reflux becomes more severe and persistent for some, especially those who carry excess weight. When acid reflux occurs regularly over several weeks, we consider it Gastroesophageal Reflux Disease, or GERD. While persistent acid reflux may seem like nothing more than a nuisance that causes burning in the chest and a bad taste in the mouth, significant concerns are associated with it when left untreated. The constant washing of acid into the esophagus and mouth can cause yellowing of teeth, persistent cough, bad breath, and very uncomfortable sensations in the chest and throat. Barrett’s Esophagus can develop in more severe cases. This is a pre-cancerous condition where the lining of the esophagus mimics that of the stomach. In some cases, Barrett’s Esophagus can eventually lead to esophageal cancer.

For patients with moderate to severe acid reflux, Proton Pump Inhibitors (PPI) have been a standard early-line standard of care when antacids don’t work; these drugs, known as omeprazole) were once sold by prescription only, but now can be found OTC under brands including Prilosec, Zegerid, Nexium, and more. These medications work by limiting the amount of acid the stomach produces rather than counteracting existing stomach acid. We’ve known for a while that PPIs, as effective as they are, do come with some significant side effects, including a greater risk of bone fracture, as well as the proliferation of harmful bacteria in the gut, including C diff. Data from a new study has shown that long-term PPI use can also increase the risk of dementia.¹

Study Details

The study group of people 45 years of age and older who took PPIs for 4.4 years or longer showed a 33% higher risk of dementia versus those who never took the drug. This indicates that despite the drug being over-the-counter, there are still potentially serious side effects, some of which don’t even materialize for many years or even decades.

The Best Way to Manage Chronic Acid Reflux

If you’ve been living with chronic acid reflux, there are possible solutions, including losing weight, which reduces abdominal pressure on the lower esophageal sphincter. Of course, losing weight is easier said than done, and while many patients may do very well at first, they can rarely keep it off over the long term. Lifestyle changes, including finishing eating earlier in the day, avoiding spicy and acidic foods, and sleeping propped up, can help but often represent a significant impediment to daily life.

A traditional fundoplication may be the best option for some patients. The surgical procedure uses a minimally invasive technique to wrap the upper portion of the stomach around the lower portion of the esophagus, offering the pressure needed to keep the esophageal sphincter closed when patients are not swallowing food and drink. Dr. Jacobs is also an expert in the newest esophageal sphincter strengthening surgery – the LINX Reflux Management System. The LINX device resembles a small, beaded bracelet with a magnetic clasp. This is placed around the lower esophageal sphincter, adding pressure. However, because of the magnetic properties, it more easily allows food and drink to pass downward while also making it easier for patients to vomit and belch if needed.

The Bottom Line

With more data about the long-term risk of PPI use coming out every year, it’s best to see a qualified general surgeon like Dr. Jacobs to understand your options for handling acid reflux medically or surgically. If you also suffer from obesity, you may benefit from a gastric bypass, which can help eliminate many of the diseases associated with morbid obesity and is, for all intents and purposes, a GERD-busting surgery as well. Approximately 90% of patients who undergo gastric bypass are entirely free of acid reflux soon after the procedure. Patients can also lose most of their excess body weight in the process.

For patients who have had a gastric sleeve and are experiencing new or worsened reflux, Dr. Jacobs performs several potential corrective surgeries, including a gastric bypass or an SASI, addressing both continued weight loss needs and acid reflux concerns. If a patient requires a hiatal hernia, this is identified and repaired during primary surgery and can also help reduce or eliminate acid reflux after surgery.

Reference:

  1. Cumulative Use of Proton Pump Inhibitors and Risk of Dementia
    The Atherosclerosis Risk in Communities Study
    Carin A. Northuis, Elizabeth J. Bell, Pamela L. Lutsey, Kristen M. George, Rebecca F. Gottesman, Tom H. Mosley, Eric A. Whitsel, Kamakshi Lakshminarayan Neurology Oct 2023, 101 (18) e1771-e1778; DOI: 10.1212/WNL.0000000000207747