DR MARTIN SCURR: The common stomach medicine that may cause dementia… and what you should do about it

I’ve stopped taking lansoprazole for my acid reflux because I’m worried it can cause dementia. I’d been on it for five years and I’ve recently started to have memory problems. I’m 78.

Name and address supplied.

Your letter illustrates a common conundrum in medicine – balancing the risks of a treatment with 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 is likely to have eased your acid reflux – and we know this is important, as repeated exposure to stomach acid can, over time, change the cells lining the oesophagus and cause a pre-cancerous condition known as Barrett’s oesophagus.

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

When considering whether to stop taking PPIs, the reason for being prescribed them must be taken into account. If it is only for the relief of heartburn, then over-the-counter antacids such as Gaviscon may be enough.

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

Indeed, there are so many factors involved in dementia that simply focusing on a potential one, such as long-term use of lansoprazole, is likely to do little to stave off the condition.

Moreover, if the drug was prescribed after an endoscopy (where a tiny camera is used to inspect the oesophagus and stomach), or another test showed the acid had inflamed or damaged your oesophagus, there is a case for staying on it.

In this scenario, you should take the lowest possible dose that fully suppresses your symptoms. Because of the risk of pre-cancerous changes to the oesophagus, I recommend you rethink your decision to come off the drugs entirely.

Over the past few months I’ve either lost my voice or my voice becomes strained. Initially, this was after doing something strenuous but now it seems to happen at any time and more frequently. I do have asthma, which has been playing up recently, and I’ve been taking two types of inhaler.

Nigel Davies, Chester.

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

One of the inhalers will be a preventer, which delivers a low-dose corticosteroid as an aerosol into your airway.

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 (found naturally in the body) – and you end up with thrush in the throat.

That’s why patients are told always to wash out their throat – perhaps by drinking a glass of water – after using the inhaler.

In some patients, the steroid leaves residues on the vocal cords. Washing out with a drink won’t clear the drug from the vocal cords, which are protected by the swallowing mechanism (and that stops you choking).

The only way to clear a yeast infection from the vocal cords is with an antifungal treatment. A single dose, 150mg capsule, of fluconazole should clear it within days. The treatment may need to be repeated after some months, as continuing on the inhalers means you are still susceptible to the thrush recurring.