Stomach

66 - Proton Pump Inhibitor Use and Risk of Dementia: Much Ado About Nothing?

Wednesday, October 10
8:40 AM - 8:50 AM
Location: Terrace Ballroom 2-3 (level 400)

Category: Stomach
Mubeen Khan Mohammed Abdul, MD1, Zubair Khan, MD, CMQ2, Shreesh Shrestha, MD3, Khwaja F. Haq, MD4, Muhammad Ali Khan, MD5, Colin W. Howden, MD, FACG5
1University of Tennessee Health Sciences Center, Memphis, TN; 2University of Toledo Medical Center, Toledo, OH; 3UTHSC, Memphis, TN; 4Henry Ford Hospital, Detroit, MI; 5University of Tennessee Health Science Center, Memphis, TN

Award: Fellows-in-Training Award (Stomach Category)

Introduction: Proton pump inhibitors (PPIs) are among the most widely prescribed drugs for the management of acid-peptic disorders. Approximately, 1 in 5 older adults in the US have used PPIs and many use them long term - although not always for appropriate indications. Recent studies evaluating a possible association between PPI use and the development of dementia have reached conflicting conclusions. Therefore, we conducted a systematic review and meta-analysis to evaluate this questionable association in the light of currently available evidence. 

Methods: We searched Medline, Embase, Scopus, Web of Science and Cochrane registry from inception through May 28, 2018, to identify studies evaluating any association between PPI use and the development of dementia. There was no restriction of language or study design. Pooled hazards ratio (HR), odds ratio (OR) and standard mean difference (SMD) were calculated and analyzed using a random effects model. Quality assessment was by the Newcastle Ottawa Scale (NOS). We used the GRADE framework to evaluate overall strength of evidence.

Results: We included 9 studies with 198,918 individuals (43,207 PPI users, 155,711 non-users).  Five studies presented results as adjusted HR, 2 as adjusted OR and 2 used a composite score difference for evaluation of cognitive decline. Six studies were high quality while the remaining 3 were moderate quality per NOS. Pooled HR with 95% confidence interval (CI) for this association was 1.12 (0.88, 1.43), I2=91%. On sensitivity analysis, by sequentially removing one study at a time, we only found a significant association with the exclusion of 1 particular study (HR 1.24; 95% CI 1.03, 1.49; I2=79%). In the 2 studies reporting OR, pooled OR (95% CI) was 0.98 (0.89, 1.05), I2=95%. As per GRADE framework, pooled evaluation based either on HR or OR qualified as very low-quality evidence. Pooled SMD for composite score was -0.00 (-0.06, 0.05), I2=0%. This would qualify as moderate quality evidence.

Discussion: Overall, the available evidence linking PPI use with dementia is of very low quality, and we have found no significant association. If PPI use in an elderly patient is for an appropriate indication, there is no justification to stop it because of concerns about dementia.


Disclosures:
Mubeen Khan Mohammed Abdul indicated no relevant financial relationships.
Zubair Khan indicated no relevant financial relationships.
Shreesh Shrestha indicated no relevant financial relationships.
Khwaja Haq indicated no relevant financial relationships.
Muhammad Ali Khan indicated no relevant financial relationships.
Colin Howden: Aralez – Consultant. Horizon – Speaker's Bureau. Ironwood – Consultant. Otsuka – Consultant. Pfizer Consumer Health – Consultant. US WorldMeds – Consultant.

Mubeen khan Mohammed Abdul

Auroa St Luke's Medical Center
Milwaukee, Wisconsin

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