In Wednesday’s diary neurology Published an article that attracted attention studyreported a possible association between the use of heartburn medications such as Prilosec and the development of dementia. It generated scary-sounding headlines, fueled conversations about drug safety, and simultaneously raised questions about how the public should make sense of conflicting results from medical research.
Our most recent publication explored data collected from people enrolled in ongoing programs. study The study began in 1987 and examined the long-term health status of 5,700 study participants who did not have dementia when they first entered the study.
Of note, this study was not originally designed to study dementia risk from these drugs. However, when the researchers examined the data they collected, they found that participants who took proton pump inhibitors (drugs often abbreviated as PPIs, such as omeprazole (Prilosec)) for more than four and a half years were more likely to develop dementia. found about 33 percent more likely to develop lag behind those who are not on the drug.
The study authors have been careful to explain that the associations shown so far do not prove causation. But the press was less cautious. “Long-term use of acid reflux medications may increase the risk of dementia,” read one of the reports yesterday. headline.The drug ‘may increase the risk of dementia by up to a third,’ it says. another.
Importantly, this study followed several studies. bigger, higher quality Studies have shown results that are the exact opposite of that conclusion. In other words, these drugs do not portend an increased risk of dementia.
What should a confused ordinary person do?
Conflicting medical research results can be incredibly confusing. And when people try to sort out what’s true, the devil is in the details, says Madhav Desai, a gastroenterologist at the University of Texas at Houston Health Science Center. “You have to be very careful when it comes to reading actual research, and even more so when you’re reading news posts out there,” he said.
After all, drugs play an important role in reducing health risks for many people. “Poorly controlled acid reflux can lead to a variety of complications, including late-stage cancer,” says Desai. So people shouldn’t quit heartburn remedies en masse based on alarming headlines.
If there seems to be a lack of consensus in medicine, take some time to understand how conflicting studies are designed and what that design means in terms of reliability of results. Worth it.
The simplest conclusion of this study is that people who need heartburn remedies should not fear them.
Proton pump inhibitors are drugs that many people take at some point in their lives. Heartburn is most common reason People take them for other reasons, such as to treat certain types of ulcers in the digestive system.
For those who need them, they are very helpful not only in controlling symptoms, but also in reducing the risk of serious complications of the disease. PPIs greatly reduce the risk of esophageal and stomach bleeding in people taking anticoagulants.
It’s not without risks.in high quality the studydrugs increase the risk of certain types of gastrointestinal infections and decrease the absorption of certain substances. important nutrients from food. But for people who need PPIs, they are very good at their job and are an important part of their treatment regimen.
Most people will get a PPI at some point. I took them off and on for years due to gastritis which turned out to be food allergies. Desai said about half of the American population will experience heartburn at some point in their lives.researchers think 20 percent of Americans have it all the time. Many symptomatic people take PPIs because their doctor prescribed them or because they bought an over-the-counter product for themselves.
Many studies have looked at the results of people who took PPIs compared to those who didn’t. It’s important to note here that people who get heartburn are more likely to get a PPI. — Desai said they are likely to differ in important ways from those who do not. That’s because heartburn is a common symptom of several common chronic medical conditions.
This is key to understanding why the new research may not have as significant an impact as some headlines have reported.
“Patients with acid reflux are more likely to be overweight and Hiatal hernia, they are obese. In some cases, they also have other potential cardiometabolic risk factors, such as hypertension and hyperlipidemia,” Desai said. All of these conditions increase the risk of developing other complications, such as cognitive decline and dementia, he said.
Large studies have shown that people who take PPIs are more likely to suffer from other medical conditions than those who do not.in Recent research 19,000 patients participated and those who took these drugs Probability is high For example, you may also be taking medications to treat high blood pressure or cholesterol.
These differences are especially important when the outcome researchers are looking for is dementia. high cholesterol, high blood pressureand Diabetes They themselves are thought to increase the risk of dementia. In fact, a study released Wednesday found that PPI users were more likely than nonusers to have high blood pressure and diabetes, and were more likely to develop dementia.
That makes it difficult to separate the potential risks of PPIs from the risks associated with the diseases they are used to treat, Desai said. However, several large-scale studies have aimed to do so, and their results are worth considering alongside many of the current high-profile studies.
The latest findings send a different message than some of the higher-quality studies that have come before.
The gold standard study for answering questions about whether a particular exposure (such as taking a drug) is associated with a particular outcome (such as developing a medical condition) is a randomized controlled trial. In this type of study, groups of people are randomly selected to take either a drug or a placebo, and the results are later compared to determine if there are differences.
Fortunately, that kind of research is being done when it comes to answering questions about PPI and dementia. In 2019, a group of researchers Randomly selected about 17,600 patients To receive PPI or placebo. The researchers found no additional risk of dementia, along with many other diseases, in people who took PPIs for three years compared to those who did not. (Three years may not be enough to confirm the onset of dementia in some people. However, the size of the study and the relatively high age of the participants, averaging 68 years, make the authors confident in their findings.) had.)
Professor Desai believes this is an “ideal study” to answer questions about the risk of dementia from PPI intake.He should know: In 2020 he review A scientific study that examines the question.
For the review, Desai’s research team included only studies that prospectively enrolled patients—that is, studies that followed patients over time to determine which factors were associated with a particular outcome. Ta.These studies are generally considered higher quality It is not a retrospective study of patient information already collected in large datasets, as most recent studies are.
Desai’s study showed that people taking PPIs for many years had no increased risk of dementia, even when looking only at people who had been on the drug for more than five years.
some more review the study The results are similar to those of Desai’s study.And the focus should be on relatively high-quality prospects study A paper published about two months ago further confirmed the lack of association between PPI and dementia.
What Confused Patients Can Do When Medical Research Conflicts
High-quality research suggests that there is no major controversy in the medical community about whether PPIs increase the risk of dementia, but the latest research and its coverage suggest that this is still an open question. It seems that there is.
Desai says that conflicting findings in the scientific literature are not a bad thing. In fact, when well-designed medical research contradicts consensus, it sparks more and even better-designed research to help move science forward.
Ultimately, patients who are unsure of what to do about conflicting research results should consult their physician as to what is best for their particular situation. Desai said each patient has different symptoms, complications and risks.
Gastroenterologists typically don’t want to take these drugs long-term if it doesn’t make sense for their patients, Desai said.
So perhaps the most important question a confused patient can ask a doctor is, “How much of this PPI do I need?”
