DR. MARTIN SCURR: The common stomach drug that can cause dementia… and what to do about it

I have stopped taking lansoprazole for my acid reflux because I am concerned that it may cause dementia. I have been using it for five years and recently I started having memory problems. I’m 78.

Name and address provided.

Your letter illustrates a common conundrum in medicine: the balance between the risks of a treatment and its benefits.

Lansoprazole is a proton pump inhibitor (PPI) – these drugs reduce stomach acid production, which reduces acid reflux.

On the plus side, the PPI probably relieved your acid reflux – and we know that’s important, because repeated exposure to stomach acid over time can change the cells lining the esophagus and cause a precancerous condition known as as Barrett’s disease. esophagus.

However, new research, including an analysis of data from nearly two million people, published in the Journal of the Alzheimer’s Association, has suggested a link between long-term use of PPIs and developing dementia.

When considering discontinuing PPI use, the reason for prescribing them should be taken into account. If it is just for heartburn relief, over-the-counter antacids such as Gaviscon may be sufficient.

However, I must emphasize that studies have only found a link between PPIs and dementia; they have not shown that the drugs cause the condition.

There are so many factors involved in dementia that simply focusing on one possible factor, such as long-term use of lansoprazole, will likely do little to prevent the condition.

Additionally, if the drug is prescribed after an endoscopy (which uses a small camera to inspect the esophagus and stomach), or if another test shows that the acid has inflamed or damaged your esophagus, there is reason to continue taking it to go.

In this scenario, you should take the lowest possible dose that will completely suppress your symptoms. Because of the risk of esophageal precancerous lesions, I recommend that you reconsider your decision to stop taking the medications altogether.

Over the past few months I have lost my voice or my voice has become strained. Initially this happened after I did something strenuous, but now it seems to happen at any time and more often. I have asthma, which has become more common lately, and I use two types of inhalers.

Nigel Davies, Chester.

What you are describing sounds like a low-grade chronic form of strep throat affecting your vocal cords. This is different from a viral infection and I suspect the problem is with your asthma inhalers.

One of the inhalers is a preventative, which delivers a low dose of corticosteroid as an aerosol into your airways.

The problem is if the steroid is allowed to build up in the tissues at the back of the throat. This can weaken the immune system in the area, leading to an overgrowth of the yeast candida albicans (which occurs naturally in the body) – and you get thrush in the throat.

Therefore, patients are told to always rinse their throat after using the inhaler – for example by drinking a glass of water.

In some patients, the steroid leaves residue on the vocal cords. Washing down with a drink will not remove the medicine from the vocal cords, which are protected by the swallowing mechanism (and which prevents you from choking).

The only way to get rid of a fungal infection of the vocal cords is with an antifungal treatment. A single dose of fluconazole, a 150 mg capsule, should resolve the symptoms within a few days. Treatment may need to be repeated after several months as if you continue to use the inhalers you may still be prone to recurring thrush.