Can Long-Term PPI Use Cause Dementia?

Acid reflux is one of the most common digestive concerns occasionally experienced by people the world over. Most people will experience some acid reflux in their lifetime, especially after a heavy meal or eating spicy food. However, acid reflux becomes problematic when patients experience it regularly, at which point it can be considered chronic – known as Gastroesophageal Reflux Disease or GERD. This condition can be very troublesome for the discomfort it causes – often a burning sensation in the chest and throat. Sometimes, the burning in the chest is bad enough that patients believe they are having a heart attack. Beyond that, GERD can cause yellowed teeth, premature wearing of tooth enamel, a persistent dry cough, esophageal stricture, and more. It can even lead to a pre-cancerous condition known as Barrett’s Esophagus. In some cases, this can lead to esophageal cancer, which can be very aggressive and challenging to treat.

For those with mild, occasional acid reflux, the first-line remedy is often an antacid like Tums, which can neutralize the acid in the stomach and improve or eliminate discomfort; however, for more chronic and severe cases, patients are often guided toward proton pump inhibitors, or PPIs, to slow the production of acid in the stomach rather than neutralizing it. These drugs initially were only available through prescription. However, they are now sold over the counter under brand names such as Prilosec and Nexium (omeprazole).

While very effective, these drugs are only indicated for six weeks of use. However, many patients take them for longer – months or even years. We know from existing data long-term use is problematic, with a higher risk of fracture in some patients as well as possible proliferation of bad bacteria, including C-diff. Beyond that, we also know that gastric juices, acidic or not, can be harmful to the esophagus; even though the burn may go away, damage is still being done.

The Study on PPIs and Dementia

According to a recent study published in the journal Neurology1, people aged 45 and over who took PPIs for over 4.4 years had a 38% increased risk of developing dementia than people who never took the medication.

Possible Alternatives

With all the potential risks of long-term PPI use, there are alternatives for our patients. First, we always suggest the patient evaluate and modify their lifestyle choices. This may include exercising more, dieting, and ultimately losing weight. Patients may also change their lifestyle habits by avoiding spicy and fatty foods, eating earlier, and sleeping propped up or on their left side. However, these are temporary solutions for a chronic problem, and most people cannot maintain this new lifestyle.

Fundoplication

The Surgical Association of Mobile also offers minimally invasive surgical solutions for chronic acid reflux. Fundoplication involves wrapping the upper part of the stomach around the lower part of the esophagus to support the Lower Esophageal Sphincter (the valve between the esophagus and stomach) and reduce the risk of gastric juices entering the esophagus.

LINX

We also offer an implantable device specifically made to address the shortcomings of the fundoplication. Known as the LINX reflux management system, this bracelet-like magnetically clasped device is placed around the lower esophageal sphincter to add pressure and reduce the occurrence of reflux. The magnetic properties of the device allow food and drink to enter the stomach while offering just enough pressure to minimize reflux in the esophagus. Similarly, patients can belch and vomit more easily.

Most importantly, if you are experiencing acid reflux, contact us. We can help you decide which medication or reflux system is right. We can also discuss the option of a gastric bypass if you qualify for bariatric surgery. In addition to being an extremely effective weight loss procedure, the bypass eliminates or improves acid reflux in virtually all patients undergoing the procedure.

Contact us to schedule a consultation for our online seminar to learn more about our weight loss surgery program. I look forward to speaking with you and assisting with your weight loss and reflux management needs.

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