Nexium: Caution


A recent study of drugs to reduce stomach acidity is causing doctors and patients to reevaluate their use. These drugs are known as proton pump inhibitors, or P.P.I.s, and they are commonly used to reduce the discomfort of heartburn, a form of indigestion felt as a burning sensation in the chest caused by acid regurgitation into the esophagus. P.P.I.s can be very important in cases of stomach ulcers or precancerous changes in the esophagus; however, heartburn can be treated in other ways. Older adults who use P.P.I.s may be at increased risk for developing dementia, according to an observational study published in JAMA Neurology.

Using claims from a large German health insurer, researchers studied nearly 74,000 adults aged 75 and older without dementia in 2004. By 2011, roughly 40 percent were diagnosed with dementia. Overall, 4 percent of participants used P.P.I.s regularly during at least one 12 to 18-month interval during the study period. After adjustment for confounders, including age, other drugs used, stroke and depression, P.P.I. use was associated with a 44 percent increased risk for incident dementia.

As potential mechanisms of action, the authors cite evidence suggesting that some P.P.I.s can cross the blood-brain barrier and affect brain enzyme levels. They call for randomized trials to confirm their observational findings.

Prolonged use of P.P.I.s has also been associated with iron and vitamin B12 deficiencies, low blood magnesium, osteoporosis-related fractures, small intestinal bacterial overgrowth and community-acquired pneumonia. These effects are believed to be related to changes in the intestinal bacteria due to acid suppression. In the case of pneumonia, it may be due to growth of bacteria in the stomach and lungs because of insufficient stomach acidity. Whether less potent acid inhibitors like histamine H2 antagonists cause similar changes to the microbiome is unknown. These drugs, such as Tagamet, Pepsid or Xantac, act within an hour or less and wear off within 12 hours. They can be used intermittently, as needed, whereas P.P.I.s are commonly used long-term.

Here are some home remedies for heartburn: Eat smaller portions at meals, consume less fat, avoid lying down for at least two hours after eating (avoid late-night snacks), wear loose-fitting clothing, elevate the head of the bed about six inches (best done by placing a block under the headboard, rather than stacking pillows), use a “bed-lounger pillow” or sleep in a reclining chair. You can also lose weight if needed (as little as five to 10 pounds may help) and avoid alcohol, tobacco and trigger foods. Chewing gum is helpful when heartburn strikes, as is sipping an ounce or two of water with baking soda.

Because P.P.I.s are among the most widely sold drugs in the world, the news about increased dementia risk and other complications is very important. Be sure to talk to your doctor, nurse practitioner or physician’s assistant about your questions. Here’s to a healthier you!


Sadja Greenwood, M.D. is a retired physician living in Bolinas.