Q: I’ve taken omeprazole (Prilosec) daily for the past several years. Am I at risk for dementia or other adverse effects?
A: Recently, there has been a lot of discussion about the safety of proton pump inhibitors (PPIs), such as omeprazole, esomeprazole (Nexium) and pantoprazole (Protonix).
First, let’s first take a look at how they work and why they are used.
Just as the name implies, PPIs work in the stomach by shutting down or decreasing the amount of acid being produced by the stomach. Acid in the stomach is necessary to help break down food to be digested, but too much acid is harmful.
The most common disorder is acid reflux, which causes the acid and-or partially digested food to come back up the esophagus.
If too much acid is exposed to the esophagus for long periods of time, Barrett’s esophagus or cancer can occur. Also, if too much acid sits in the stomach, ulcers might develop.
The media recently reported two potential adverse outcomes of taking PPIs – dementia and kidney failure. Another previously well-known possible outcome is bone fractures.
What prompted the new discussion is a study that was reported Feb. 15 in the Journal of the American Medical Association (JAMA) Neurology. It looked at more than 73,000 patients taking PPIs in a pharmaceutical database, with patients aged 75 and older who did not have a previous diagnosis of dementia.
Over the course of the seven-year study, more than half of the patients on PPIs were diagnosed with some form of dementia.
Patients seemed to have a higher incidence of dementia if they were taking PPIs longer than 12 months.
A similar article in JAMA Internal Medicine last month looked at a large population of patients with normal kidney function and found that frequent PPI use was associated with worsening kidney function over a few years.
Even though these studies sound significant, they show only a possible association, not a documented cause and effect. Therefore, PPIs have not been proven to cause dementia, kidney failure or bone fractures.
The studies that have been done so far are mostly observational studies. To prove that a drug causes a long-term problem, you need prospective, randomized, controlled trials.
Always ask your doctor about the significance of these studies before starting or stopping medication.
Still, we should not ignore the results from these studies. Millions of people take PPIs; some likely take them for the wrong reasons.
Talk to your healthcare provider about whether you need to take this medication daily or if intermittent or short-term use will work for you.
Dr. William E. Kyle is an internal medicine physician at Memorial Health University Physicians – Legacy Center in Okatie.