2016-02-18 15:03:22 UTC

How to Talk with Your Patients About PPIs and Dementia

Feb. 18, 2016

A new study might raise concerns among patients about the use of PPIs.

A recent study published in JAMA Neurology, “Association of Proton Pump Inhibitors With Risk of Dementia,” has raised questions among patients and health-care professionals. Here are some notes on interpreting the study and how to talk about it with patients.

Interpretation
The study, from Germany, is based upon insurance claims data and demonstrates a statistical association of dementia and long-term PPI use, not causation. Additional studies will need to be performed to prove that avoiding PPIs prevents dementia from developing.

This study, like most PPI-adverse effect studies, focuses on long-term users. Clinicians should recognize that PPIs are highly effective in treating acid-related disorders and also that there are few hard indications for long-term PPI use, including truly refractory GERD (with an abnormal pH study), Barrett’s esophagus, Zollinger-Ellison syndrome, idiopathic ulcers and, arguably, as prophylaxis against bleeding in select patients. 

Talking to Your Patients

  1. Reassure patients that you prescribed a PPI for a clear-cut indication, in the lowest possible dose, and for an appropriate period of time (lowest dose, shortest time). This advice echoes that offered by AGA and ABIM in the Choosing Wisely campaign. 
  2. Educate patients not to ask “what side effects do PPIs have?” but rather “is it really indicated?” Reassure patients that, when PPIs are indicated, benefits outweigh risks.
  3. Keep conversation channels open with patients. When patients require long-term use of PPIs, the medication should not be stopped without a discussion with you about the risks and benefits. 
  4. Recommend that patients also consider life-style modifications that may reduce or eliminate the need for PPIs for long-term use, as was concluded in the study “Lifestyle Intervention in Gastroesophageal Reflux Disease.”

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