January 07, 2020
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No evidence for link between PPIs and dementia

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Researchers found no clinically meaningful association between short-term proton pump inhibitor therapy and increased risk for dementia, according to the results of a meta-analysis.

Colin W. Howden, MD, FACG, Hyman Professor of Medicine and chief of the division of gastroenterology at the University of Tennessee Health Science Center, and colleagues wrote that proton pump inhibitors have been linked with adverse events in the past, including dementia. However, studies that have explored these risks have returned conflicting results.

“Proton pump inhibitors are widely used but, in recent years, have been linked to a wide variety of possible adverse reactions,” Howden told Healio Gastroenterology and Liver Disease. “Initial reports of a link between PPIs and dementia received a lot of media attention and caused a lot of anxiety among patients, their family members and their health care providers. Subsequent — and better quality — studies did not find an association between PPI use and dementia, but, sadly, these did not attract media attention.”

To evaluate this proposed association further, Howden and colleagues searched the literature for studies that explored the potential link between PPIs and dementia. They determined pooled hazard and odds ratios for studies reporting summary results.

They identified 11 observational studies that fit their criteria. The studies comprised 642,949 individuals, 158,954 of whom used PPIs. Study range lasted in length from 5 to 10 years.

Among the studies that summarized data such as adjusted HR, the pooled HR for all causes of dementia was 1.1 (95% CI, 0.88–1.37) and 1.06 for Alzheimer dementia only (95% CI, 0.72–1.25).

For studies that used adjusted OR, the pooled OR for all causes of dementia was 1.03 (95% CI, 0.84–1.25) and 0.96 for Alzheimer dementia only (95% CI, 0.82–1.11).

Howden highlighted that the findings do not support the proposed association between PPIs and increased risk for dementia.

“Patients who are on PPI treatment for a valid reason should not stop it because of concerns about dementia risk,” Howden said. “Elderly patients should not be denied PPI treatment if they have a valid indication for it. Patients who are on PPI treatment for unclear reasons should discuss their continued need for it with their doctors. If they do not have a continued need for it, it should be stopped but not because of residual safety concerns.”

Disclosure: Howden reports consulting for Biopharma, Ironwood, ISOThrive, Otsuka, Phathom, and RedHill. All other authors report no relevant financial disclosures.