Regular proton pump inhibitor use potentially associated with increase in dementia incidence

1. Regular proton pump inhibitor (PPI) use contributed to an increased incidence for all-caused dementia. 

Evidence Rating Level: 2 (Good) 

Proton pump inhibitors (PPIs) are commonly used for managing gastric acid-related disorders including gastroesophageal reflux disease (GERD), peptic ulcer disease, and for the eradication of Helicobacter pylori. Several countries promote the purchase of PPIs over the counter, and these are additionally often prescribed in hospitals for incorrect indications and long-term use. Given the increased use of PPIs, more research has been conducted exploring potential adverse effects. However, the association between PPI use and dementia has not been investigated in detail. In this population-based prospective cohort study, 501,002 participants from the UK Biobank were followed for their PPI use, and all-cause dementia. Amongst PPI users, the incident rate of all-cause dementia was 1.06 events per 1000 person-years versus 0.51 events per 1000 person-years among PPI non-users. Individuals who regularly used PPIs were at a greater risk for developing dementia compared to individuals who did not regularly use PPIs (HR 1.20, 95%CI 1.07-1.49). In conclusion, this population-based cohort study showed that regular PPI use was associated with an increased incidence of all-cause dementia, which is consistent with prior research in this field. This study had several strengths including its large sample size and extended follow-up period. However, there were challenges with assessing correct dosage and duration of PPI use which may present a source of bias. As well, only 10% of the total study population used PPI regularly and this was not preassigned to participants. Given various clinical indications for PPI use, it is difficult to determine whether other comorbidities contributed to dementia in individuals using PPIs regularly. Further randomized controlled trials and experimental research can be valuable to assess and confirm the relationship between PPI use and dementia proposed in this study. 

Click to read the study in BMC Medicine

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