PPI use and risk of dementia

[cheezncrackers]

I've seen a number of articles in the press recently about the raised risk of dementia (+33% for anyone on PPIs for longer than 4.5 years) and I was wondering if anyone else who takes them is worried and/or has seen their GP? I will be making an appointment to speak to mine asap, but I'd be interested to know what GPs are saying about this.

I've been on lansoprazole for 5 years for bad gastric reflux. I suspect mine is peri-menopause related, as digestive issues seem to be more common at this stage of life. I tried coming off my PPI recently and the symptoms were so horrendous (waking in the night with heartburn, acid rising up my esophagus causing me to cough, constant feelings of nausea and a horrible taste in my mouth of stomach acid), that I went back on it.

This article talks about how to change your diet and way of eating to avoid acid reflux, but as someone whose diet is already severely affected by IBS I've already made most of these changes already.

https://www.dailymail.co.uk/health/article-14136667/pharmacist-warning-omeprazole-acid-reflux-drugs-heartburn-dementia.html

Please be wary of these articles. If you do some further reading online it actually relates to B12 deficiency which sometimes - not always - occurs from long term use of ppis. B12 deficiency is fairly easy to identify and treat. Holes in your oesophagus and stomach caused by acid are not. I know which I’d rather have.

I take esomeprazole 40mg daily long term for issues caused by steroids - I have Addisons disease and need to take steroids to stay alive. Most people with Addisons etc need a ppi long term. I think articles like this are really dangerous, they’re not in depth enough and no one should stop medication without evaluating their personal circumstances.

As with all medications you need to assess whether for you personally the benefits outweigh the risk. There are many people on PPIs inappropriately or taking an inappropriate dose. For example, lots of people get left on high treatment doses when they could be stepped down to a maintenance dose. If you are concerned I would recommend reviewing your medication with a GP or Pharmacist.

Articles like this are caused at least in part by society's inability to recognise that some people really are actually ill. And that illness is not usually a result of personal failings.

If you need the PPI keep taking it and don't worry. If not, talk to your GP about cutting back.

The studies on long-term PPI use and risk of dementia have actually been quite mixed, but the studies indicating no link rarely receive media coverage.

No study to date has shown causation.

That said, there are downsides to long-term use and it's worth discussing with your doctor. Keep in mind that after you've been on PPIs for an extended period you are likely to experience rebound acid reflux when you attempt to stop the drugs. I was able to taper off esomeprazole very slowly but still experienced pretty grim reflux for a number of weeks. Once that passed I was absolutely fine and I haven't needed heartburn meds for 6+ years. But my brother will be on them for life due to changes in the lining of his esophagus. Not everyone can avoid long-term use and, for some, the benefits outweigh the risks.

As others have said you have to weigh up risk v benefit.
I take PPIs only as a last resort because there is a link to osteoporosis (which I already have) I think it's because they reduce absorption of calcium as well as other nutrients.

I think it's also a thing that when you stop taking PPIs your symptoms get worse temporarily. Maybe if you could manage them with alternatives such as antacids for a while it might work?

Thank you to everyone who posted in reply and for some reassurance. I already take 200% RDI of Vit B12 and I take calcium and Vit D, but I do need to speak to my GP about the risks of staying on the medication long-term. I'm on 30mg, I don't know whether that's a high dose or not, but I suspect it isn't, because it's just what I was put on initially and I've never had it put up, that dosage being sufficient most of the time. When it's not enough though I end up drinking about half a medium bottle of Gaviscon per day to counter the symptoms. I really feel currently that I do need to be on this medication, but I definitely don't want to get dementia

Dh is a Gastroenterologist and as he says this is a case of "correlation is not causation". And each person's circumstances will be different, you don't want to put yourself at risk of Barrats oesophagus or God forbid esophageal cancer. If you want to see if you can manage on a lower dose, or just taking them every other day then it's worth a chat with your GP.

I'm on 30mg, I don't know whether that's a high dose or not, but I suspect it isn't, because it's just what I was put on initially

That's the highest dose it comes in. Generally that's prescribed for the initial 8 weeks then reduced to 15mg for maintenance.

If you and your doctor decide to try to reduce your dosage I'd very highly recommend a long slow tapering process. You will almost certainly experience rebound acid reflux before things gradually improve.

Thanks @MissyB1. My FIL got esophageal cancer and had had gastric reflux for years so that's definitely a fear of mine. However, he was also a pipe smoker, so it could've been that too.

@CulturalNomad oh that's the highest dose? Okay, I think a meds review with GP is needed. It shocking how you just get put on something and then never called in to review the dosage. I have this on a repeat prescription with no reviews required ever!

shocking how you just get put on something and then never called in to review the dosage. I have this on a repeat prescription with no reviews required ever!

That is exactly what happened to me. I started having severe reflux right around menopause and tried all the dietary/lifestyle measures to no avail and was given a script for a PPI which was renewed without any discussion for the next 4+ years.

This was back in 2013 and there wasn't much buzz about long-term effects, but I definitely should have been more proactive and done my own research.

I did not have damage to my esophagus so was able to eventually discontinue use but I can't lie - it wasn't easy. The rebound acid reflux was awful. But I'm fine now and am never bothered by heartburn/reflux. I shouldn't have been on them long-term.

I have a hiatus hernia diagnosed 2.5 years ago and have Lansoprazole but only take it during flares up so for a couple of weeks at a time and try and manage without where possible and this has been my regime before I read about the possible link.

I got moved from PPIs to an H2 blocker - famotidine. As far as I know these aren't linked to dementia. Why aren't these prescribed instead of PPIs? Is it a cost issue?