Long-term heartburn pills are tied to higher kidney and dementia risk

They are among the most widely used drugs in the world, sold both by prescription and over the counter, and taken by millions of people for heartburn, acid reflux, and ulcers. Proton-pump inhibitors, the class that includes omeprazole, esomeprazole, and lansoprazole, are highly effective at shutting down stomach acid production. But a series of observational studies over the past decade has raised questions about what happens when people stay on them for years, linking prolonged use to a modestly higher risk of kidney disease and dementia, among other concerns.

The findings have not shown that the drugs cause these problems, and researchers repeatedly caution that association is not proof of cause. Still, the accumulating signals have prompted doctors and regulators to urge a more careful approach: using the lowest effective dose for the shortest necessary time, and periodically reassessing whether long-term users still need the medication at all.

How proton-pump inhibitors shut down stomach acid

Proton-pump inhibitors work by blocking an enzyme system in the stomach’s lining known as the hydrogen-potassium pump, the final step through which cells secrete acid. As their pharmacology explains, this makes them more powerful and longer-lasting acid suppressors than older drugs such as antacids or H2 blockers. That potency is exactly what makes them so effective for conditions like gastroesophageal reflux disease, peptic ulcers, and the prevention of stomach bleeding in people taking certain other medications.

For short-term use, the drugs are generally considered safe and well tolerated. The uncertainty centers on the large number of people who end up taking them for months or years, sometimes without a clear ongoing reason, because the medications are cheap, easy to obtain, and relieve uncomfortable symptoms quickly.

The signal linking long-term use to dementia

One of the more widely discussed findings concerns cognitive decline. A study published in the journal Neurology examined older adults and found that people who had taken prescription proton-pump inhibitors for more than about four and a half years had a higher rate of newly diagnosed dementia than those who never used them. In the reported analysis of cumulative use, the long-term users showed roughly a one-third higher risk, while shorter-term and current use showed no significant association.

The researchers who conducted that work, summarized in an American Academy of Neurology announcement, stressed that the study could not establish that the drugs cause dementia and did not recommend that people stop taking them on their own. It provided what scientists call Class III evidence, a level that flags an association worth investigating rather than a proven cause-and-effect relationship.

Kidneys, bones, and other reported risks

Dementia is not the only concern raised in the literature. Long-term proton-pump inhibitor use has also been tied in observational studies to chronic kidney disease, acute kidney injury, bone fractures, low magnesium levels, and certain gut infections. A systematic review of the evidence found that several studies reported statistically significant associations between prolonged use and these adverse outcomes, particularly in older or already-ill populations.

The same review was blunt about the limitations. Many of the studies were vulnerable to confounding, meaning the people who take these drugs long-term may differ from non-users in ways that independently affect their health, and observational designs cannot prove the drugs are responsible. The authors called for cautious prescribing and periodic reassessment rather than alarm.

Why proving cause and effect is so hard

The central challenge running through this research is that people are not randomly assigned to take these medications for years. Long-term users tend to be older, to have more medical conditions, and to take more other drugs, all of which raise the risk of dementia, kidney problems, and fractures on their own. Untangling the effect of the medication from the characteristics of the people taking it is genuinely difficult, and different studies have reached different conclusions.

That is why the strength of these findings varies and why no regulator has pulled the drugs from the market. The signals are consistent enough to warrant attention but weak and confounded enough that a firm causal verdict remains out of reach without the kind of large randomized trials that are hard to run over many years.

What the caution means for long-term users

The practical response from medical experts has been measured. The consensus is not that proton-pump inhibitors are dangerous drugs to be avoided, but that they are often taken for longer than necessary. Guidance emphasizes matching the duration of treatment to the actual medical need, using the lowest dose that controls symptoms, and considering deprescribing, a gradual, supervised reduction, for people at low risk who no longer clearly require the medication.

For those with genuine ongoing indications, such as severe reflux disease or a history of ulcer bleeding, the benefits of continued treatment can outweigh the uncertain risks. The recurring message from researchers is that decisions about starting, continuing, or stopping should be made with a clinician rather than in reaction to a headline, since abruptly quitting can cause a rebound surge of acid.

Part of what fuels concern is scale. Because these medications are so easy to obtain and so effective at quieting symptoms, large numbers of people take them for years without the periodic review that a prescription-only drug might prompt. Even a small increase in risk, spread across a population of tens of millions of long-term users, could translate into a meaningful number of cases, which is why researchers argue the potential downsides deserve scrutiny even while the causal question stays open. The prudent path, most agree, is neither panic nor complacency but ongoing evaluation of whether continued use is truly needed.

This article was produced with the assistance of AI and reviewed by Morning Overview editors prior to publication.

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