Studies Link Some Stomach Drugs To Alzheimer's Disease and Kidney Problems (scientificamerican.com)

While the recommended dosage for Nexium, Prevacid and Prilose is just two weeks, doctors often advise patients to continue taking them for years. But now Scientific American reports that "Chronic use of popular heartburn medicines may be riskier than was thought," citing two papers linking the drugs to an increase risk of dementia, including Alzheimer's disease, and a greater risk of kidney problems. schwit1 quotes their report: The papers did not prove that PPIs cause the problems. But some researchers have nonetheless suggested possible mechanisms by which long-term use of the drugs could trigger dementia or kidney problems. A reduction in vitamin B12, for example, might leave the brain more vulnerable to damage, says Britta Haenisch, an author of the JAMA Neurology study and a neuropharmacologist at the Bonn campus of the German Center for Neurodegenerative Diseases. Last spring clinicians at the Houston Methodist Research Institute reported another plausible explanation for how PPIs might lead to these unexpected health issues: they picked up signs that the drugs act not only in the stomach but elsewhere in the body, too.
The article ends on an ambiguous note. "Without conclusive data, physicians and patients have to balance the need to prevent the ill effects of excess stomach acid and reflux with the desire to avoid potentially serious -- if theoretical -- side effects from long-term use of PPIs."

Comments

Recommended dose is two weeks for OTC

[Anonymous Coward]

The recommended dose is two weeks for the over the counter (OTC) versions of the medications. That's so you don't keep taking it by yourself when you have symptoms that need an evaluation by a doctor.

Re:Recommended dose is two weeks for OTC

[slashrio]

So what's wrong with supplementing vit B12 methylcobalamin? Problem 1 solved. Cheaply.

Re:Recommended dose is two weeks for OTC

[omnichad]

Because that's only one problem.

The PPIs also slow down acid production in the lining of blood vessels, meaning they can't clear out damaged proteins. This is the cause for the kidney problems, as mentioned in the article.

Re:Don't use a PPI

[dmr001]

• 1. If I had a nickel for every time I had a heart to heart talk with a patient about improving their diet and exercise regimen to avoid the untoward consequences (reflux, overweight, diabetes, heart disease, feeling like crap in general) I'd have, like, a lot of nickels.
• 2. Interestingly, a response I get that's more common than you'd think is "I'm not switching from Pepsi to water. I hate the taste of water." We call this "pre-contemplative."
• 3. Some folks eat quinoa and twigs and still have risky acid reflux (with risks including esophageal cancer, bleeding, and cooking their esophagus sufficiently in acid it narrows - kind of like ceviche). While H2-blockers are first line, if they don't do the trick, sometimes proton pump inhibitors are the least worst thing.

Complex issue

[dr.Flake]

First:
It is unwise to immediately and completely change ones medications or prescription habits just based on one study. These large observational multivariate studies are always hindered by bias, though trying hard to compensate for them.

On the other hand, these kind of findings should not be ignored.

Proton pump inhibitors are already known for a long time to cause trouble. The article already mentions several, like the bacteria get a change of growing in the changed environment of the stomach, a defensive barrier is removed, certain vitamins and drugs need the acidity to get absorbed etc etc. Kidney issues are also not news. Other weird side effects, like I'll never forget a patient with an extreme hypomagnesia, like 0.10 mmol/l or so. She did not feel well.

But not forget the number of patients who have gained significant quality of life and the reduction of severe gastric bleeding. Remember the time where Bilroth gastrectomies were as common as cholecystectomies. The two week maximum advise for the over the counter drugs is because of the risk of patients masking a serious condition like malignancies.

But there is no denying that most people at some point start their PPI for some discomfort, and continue to swallow them for the rest of their lives. (Ideal drug for pharmaceutical companies.) The majority should just quit them, change their food habits and posture and get on with their lives.

The use of these drugs should be reserved for those who really need them. Right now it is prescribed more or less as a luxury drug