Small Bowel Bacterial Overgrowth
By Asif M. Qadri, MD
Doctor, I take a proton pump inhibitor (PPI); Does that mean I am going to develop Alzheimer’s dementia?” This has been the most common question I have to answer these days thanks to a recent article published in a well-known and trusted medical journal. Gastroesophageal reflux disease aka GERD has been a common problem for millions of Americans. Given our abundance of food and poor dietary habits however, this problem will only increase. For years we have used H2 blockers and Proton Pump Inhibitors (PPIs) to help alleviate the symptoms of reflux and heartburn with great success. However, these medications, more notably the PPIs, have been linked to multiple health concerns. Some of these include Clostridium difficile diarrhea, pneumonia, interstitial nephritis, chronic renal disease, re-occlusion of cardiac bare metal stents and decreased levels of magnesium to name a few. More recently, dementia has been added to this list.
Common PPIs known to you may include Prevacid, Nexium, Prilosec, Dexilant or Protonix to name a few. These are medications specifically designed to decrease the acid secretion in the stomach. They have been extremely successful medications to treat acid reflux or GERD in the United States and worldwide. In a recent study published by a German consortium in the Journal of the American Medical Association (JAMA), Neurology Edition, a very large group (>73,000) of men and women were studied who were aged greater than 75. Controlling for common variables, it was found that the regular use of PPIs increased the risk of dementia in men by 52% and in women 42% compared to those who did not use PPIs. In other words, greater than 29,000 individuals who did not have dementia prior to the start of the study developed dementia over an eight-year period. It is noted that further studies will be needed to validate these findings but around 44% of people developed a new diagnosis of dementia when compared to those who did not take a PPI. The most commonly cited medications were Prilosec, Protonix and Nexium. Of the three aforementioned medications, Nexium carried the highest risk. The data suggest but do not prove that taking PPIs can cause dementia but mention that there may be an association. The researchers’ analysis accounted for some but not all factors that may have contributed to the development of dementia. PPI data was based on prescriptions; whether study participants also used over-the-counter PPIs was not indicated.
One leading researcher in the field of dementia also mentioned that H2 Blockers (H2RA) such as Pepcid, Zantac and Tagamet were also linked to increased risk of dementia. It has been reported that over 15 million people use PPIs in the United States, and it is felt that we as physicians may over prescribe. However, it is also felt that perhaps patients themselves are over treating what may be only a minor case of reflux disease. It has also been mentioned that eventual weaning off of the medication would prove beneficial as well. A leading authority in brain and aging was quoted as saying that the exact cause of brain deterioration is unknown and there is no reason at this time to recommend that people stop taking acid reducing agents. It is felt that the medication will cross the blood brain barrier whereby they have an effect of the build-up or breakdown of amyloid.
One of the flaws with the study was that researchers could not control for body weight or the participant’s diet. The reason for this is that both of these are major risk factors for the development of cognitive decline and dementia. Also this is an observational study and not a randomized, double blind placebo-controlled trial.
The take home message to you is you control your health. Discuss with your doctor the risks and benefits of any medication you start. Find out if there is a potential end date regarding the use of medications and are there alternative treatments for perhaps getting cured of the diagnosis.
I look forward to meeting with you and thereby assisting you answer these questions at Athens Digestive Healthcare Associates (ADHA). We, Dr. Asif M. Qadri and the staff at ADHA, are proud to have recently been ranked #2 in the State of Georgia for Gastroenterology Physicians by Healthgrades 2015 Year-End Review.
