Gastric acid suppressants increase dementia risk

The use of gastric acid-suppressive agents, such as proton pump inhibitors (PPIs) and histamine type-2 receptor antagonists (H2RAs) may aggravate the risk of dementia among patients with upper gastrointestinal disease (UGID), a recent Taiwan study has found.

Using 2000–2015 data from the national Longitudinal Health Insurance Database, the researchers conducted a retrospective cohort study on 6,711 UGID patients who were on gastric acid-suppressive agents. The outcome of interest was dementia, and its incidence was compared against 6,711 UGID patients without such medication, and 6,711 controls without UGID or treatment.

Over 10 years of follow-up, 457 UGID patients on gastric acid-suppressive medications developed dementia, yielding an incidence rate of 6.81 percent. In comparison, the incidence rate was 4.46 percent among patients not on such medication, and 3.64 percent among controls.

Cox proportional hazard analysis found that UGID patients taking suppressive agents were nearly 50 percent more likely to develop dementia than comparators not on similar medications (adjusted hazard ratio [HR], 1.486, 95 percent confidence interval [CI], 1.283–1.721; p<0.001). This analysis was adjusted for age, sex, comorbidities, and other medications.

Notably, no such effect was detected when the nonmedicated UGID patients were compared against controls (adjusted HR, 1.129, 95 percent CI, 0.947–1.346).

Stratifying according to the type of agent taken showed that PPIs (adjusted HR, 1.836, 95 percent CI, 1.345–2.507; p<0.001) had a stronger effect on H2RAs (adjusted HR, 1.359, 95 percent CI, 1.102–1.676; p<0.01). Notably, PPI use was even a significantly greater risk factor for dementia than H2RAs (adjusted HR, 1.462, 95 percent CI, 1.038–2.057; p<0.05).