Clinical Use of Acid Suppressants and Risk of Dementia in the Elderly: A Pharmaco-Epidemiological Cohort Study

Chen, Liang-Yü; Lin, Hongbo; Wu, Wen-Tung; Chen, Yong‐Chen; Chen, Cheng-Li; Kao, Jing; You, San–Lin; Chou, Yu Ching; Sun, Chien‐An

doi:10.3390/ijerph17218271

Cited by 28 publications

(39 citation statements)

References 45 publications

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“…3 Forest plots showing the association between H2RA use and risk of dementia (Aβ) deposition in the brain, which will further contribute to cognitive impairment or decline [9][10][11]. Prior epidemiological studies demonstrated that PPI or H2RA use increased the risk of dementia [12,28]. However, the relationship between vitamin B 12 deficiency and dementia is not well defined.…”

Section: Discussionmentioning

confidence: 99%

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No association between acid suppressant use and risk of dementia: an updated meta-analysis

Wang

Tian

Yan

2021

Eur J Clin Pharmacol

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Purpose Findings from large observational studies on whether the use of acid suppressants increases the risk of dementia have been inconsistent. Since proton pump inhibitors (PPI) and histamine-2 receptor antagonists (H2RA) are the most commonly used acid suppressants in clinical practice, we performed a meta-analysis to examine the influence of PPI and H2RA on the risk of dementia. Methods A systematic search was performed on the PubMed, EMBASE, and Cochrane Library databases to identify studies published up to April, 2021. Studies that reported adjusted hazard ratio (HR) with 95% confidence intervals (CI) for the associations of interest were included. Data in the included studies were pooled using the random-effects model for metaanalysis. Statistical analysis was performed using Stata version 12.0 software. Results Seventeen studies involving 1,251,562 participants were included. It was found that PPI users were not likely to develop dementia compared with those not taking PPI (HR = 0.98, 95% CI: 0.85-1.13). Subgroup analysis based on publication year, location, mean age, duration of PPI use, and female proportion also revealed no association between PPI use and dementia risk. Similarly, H2RA use was not associated with the risk of dementia, as indicated by the pooled HR of 1.20 (95% CI: 0.98-1.47). Conclusion Results of this meta-analysis suggest that PPI and H2RA do not increase the risk of dementia. These results may be used to inform the clinical application of acid suppressants. However, further randomized controlled trials are needed to confirm the present conclusions.

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Section: Discussionmentioning

confidence: 99%

“…The full texts of the remaining 53 articles were examined in detail, of which 36 articles were excluded according to the selection criteria. Finally, 17 studies were included for the present meta-analysis [3,[12][13][14][15][17][18][19][20][21][22][23][24][25][26][27][28]. A flowchart of the literature search is presented in Fig.…”

Section: Literature Searchmentioning

confidence: 99%

No association between acid suppressant use and risk of dementia: an updated meta-analysis

Wang

Tian

Yan

2021

Eur J Clin Pharmacol

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“…The general drawbacks of retrospective studies are nicely pinpointed by reports of Tai et al (2017), Chen et al (2020) and Wu et al (2020). All three studies rely on population-based retrospective cohort studies using the same Taiwan National Health Insurance Research Database (N-HIRD).…”

Section: Germanymentioning

confidence: 99%

The Janus-like Association between Proton Pump Inhibitors and Dementia

Papazoglou

Arshaad

Henseler

et al. 2021

CAR

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: Early pharmacoepidemiological studies suggested that Proton Pump Inhibitors (PPIs) might increase the risk of Alzheimer’s Disease (AD) and non-AD related dementias. These findings were supported by preclinical studies, specifically stressing the proamyloidogenic and indirect anticholinergic effects of PPIs. However, further large-scale pharmacoepidemiological studies showed inconsistent results on the association between PPIs and dementia. Pharmacodynamically, these findings might be related to the LXR/RXR-mediated amyloid clearance effect and anti-inflammatory action of PPIs. Further aspects that influence PPI effects on AD are related to patient-specific pharmacokinetic and pharmacogenomic characteristics. In conclusion, a personalized (individualized) medicinal approach is necessary to model and predict the potential harmful or beneficial effects of PPIs in AD and non-AD-related dementias in the future.

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“…Over the years, multiple studies have suggested that the long-term use of PPI is in fact associated with increased risk for developing variant infections, e.g., community-acquired pneumonia [4], spontaneous bacterial peritonitis [5], and Clostridium difficile infection [6][7][8]. On another note, PPI use has been also linked to developing asthma [9], dementia [10], pancreatic cancer [11], and colorectal cancer [12]. Furthermore, PPI use has been investigated as a possible factor linked to increased risk for developing of cryptogenic liver abscess in patients of Asian descents [13].…”

Section: Introductionmentioning

confidence: 99%

Is the Use of Proton Pump Inhibitors a Predisposing Factor for Pyogenic Liver Abscesses?

et al. 2021

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Background: Proton pump inhibitors (PPIs) increase gastric pH by reducing acid production. The resulting alkaline milieu in the stomach increases the risk of bacterial translocation. This study aimed to investigate if there is a correlation between PPI use and developing pyogenic liver abscesses. Methods:In this retrospective case-control analysis, we studied adult patients diagnosed with cryptogenic liver abscess at Northwell hospitals between 2015 and 2019. Adult patients with the diagnosis of liver abscess were included. We excluded patients with history of liver abscess prior to admission, biliary disease, hepatobiliary malignancy, or intra-abdominal infections. A group of randomly selected patients without liver abscess from the same hospitals' database were enrolled as the control group. A multivariate logistic regression analysis was performed to adjust for potential confounding factors. Results:We identified 277 patients diagnosed with first episode of pyogenic liver abscess. Cases were compared to 554 controls. Klebsiella pneumonia was the most common pathogen. PPI use was associated with an increased risk of developing a first episode of pyogenic liver abscess in univariate (odds ratio (OR): 2.36, 95% confidence interval (CI): 1.70 -3.27), and multivariate analysis (adjusted OR: 2.27, 95% CI: 1.55 -3.32). Conclusion:This study is the first US population-based analysis to demonstrate that PPI use is associated with increased risk of developing pyogenic liver abscesses. Further prospective studies are needed to shed more light on this association and better evaluate the impact of dose and duration of PPI exposure.

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Clinical Use of Acid Suppressants and Risk of Dementia in the Elderly: A Pharmaco-Epidemiological Cohort Study

Cited by 28 publications

References 45 publications

No association between acid suppressant use and risk of dementia: an updated meta-analysis

No association between acid suppressant use and risk of dementia: an updated meta-analysis

The Janus-like Association between Proton Pump Inhibitors and Dementia

Is the Use of Proton Pump Inhibitors a Predisposing Factor for Pyogenic Liver Abscesses?

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