Dementia from PPIs: A hypothesis that may have led to gastrointestinal bleeding
Over the past week, while covering the inpatient gastroenterology service, we cared for three patients who were hospitalized with gastrointestinal bleeding who were found to have large, potentially life-threating, stomach ulcers. All three of the patients had abruptly stopped their acid-suppressing proton pump inhibitor (PPI) medication in the preceding 1 to 2 weeks. With PPIs being a primary therapy for gastroesophageal reflux and ulcer treatment, why would these patients have stopped their PPIs without medical consultation? Unanimously, they had all heard on the news that a new study found that PPIs might cause dementia. This past month, a recent study in JAMA Neurology by Gomm and colleagues from the German Center for Neurodegenerative Diseases reported that PPI usage among those over the age of 75 may be associated with a risk of dementia. While the study findings showed a statistical association, it is important to understand the limitations of their findings and how interpretation of these results can lead to significant consequences. The authors were fair in pointing out certain limitations in their study, and an accompanying editorial by Dr. Kuller further highlighted that while the authors’ findings are potentially important, they are unable to draw the conclusion that PPIs cause dementia. Furthermore, the American Gastroenterological Association (AGA) and other gastrointestinal societies have released statements on how to interpret such a stud...
ConclusionsBleeding outcomes in liver disease patients were associated with those procedures that required previous blood transfusion usually with basal platelet count
Conclusions: PCM occur predominantly in white men, and the main clinical aspect was painful mulberry-like ulcer on the tongue. The recognition of oral lesions is important because sometimes they are the first manifestation of PCM, frequently preceding even pulmonary lesions.
We present the case of a 29-year-old female patient, who presented with an exophytic lesion that was soft, painful, and bleeding, located at the level of the interdental papilla between the 11th and 21st teeth.
This study described the clinical and histopathologic data of 6 cases diagnosed as oral plasmablastic lymphoma (PBL) retrieved from the files of 2 Brazilian oral pathology services from 2000 to 2018. The mean age at presentation was 41.5 years, with a male predominance of 2:1. Involved sites were the palate, maxillary mucosa, and mandibular mucosa. All cases presented as a combination of ill-defined swellings and ulcers, with pain or bleeding. Histopathologic features revealed the proliferation of large cells, with round to ovoid eccentric nuclei, and peripheral nucleoli, as well as plasmablastic cells with prominent nucleoli.
Central hemangioma (CH) of the jaws is a rare benign vascular neoplasm of variable radiographic appearance. A 32-year-old man was referred for evaluation of an ulcerated mass on the anterior mandible causing facial asymmetry for the last 6 months. The patient reported progressive growth and bleeding episodes. Intraoral examination revealed an erythematous and necrotic swelling in the lower anterior gingiva. Computerized tomography revealed a well-defined multilocular hypodense lesion involving the mandibular symphysis, containing hyperdense foci, with expansion and destruction of the buccal cortical bone, and teeth displacement and mobility.
A 63-year-old white male presented with maxillary gingival swelling for a 6-month duration. Medical history revealed diabetes and hypertension. Extraoral examination was noncontributory. Intraoral exam showed a red bleeding lobulated nodule measuring 5.0 × 3.0 cm in the left maxillary gingiva. The presumptive diagnosis was nonneoplastic reactive lesion. An incisional biopsy was performed and histopathologic diagnosis was unspecific malignant neoplasm. The initial immunohistochemical panel was inconclusive.
Fanconi anemia (FA) is a rare autosomal recessive genetic disorder, characterized by congenital malformations of certain organs, thrombocytopenia, and chronic anemia due to the progressive failure of bone marrow, with an elevated risk of infections and bleeding. A 24-year-old male patient with FA was referred to our clinic with a chief complaint of cheek biting and resultant significant bleeding. During clinical evaluation, a traumatic ulcer in the left buccal mucosa was observed with a massive blood clot formed inappropriately along with continuous bleeding.
Juvenile spongiotic gingivitis (JSG) is an uncommon entity with a predominance for girls, with the majority of patients in the second decade of life. The idiopathic gingival papillokeratosis with crypt formation (IGPC), described in March of 2017, affects the maxillary attached gingiva of both genders in the second decade of life. A 19-year-old female patient came to our clinic complaining of "red gingiva." Oral examination showed diffuse erythema, edema, and bleeding on the marginal gingiva associated with asymptomatic white plaques involving the anterior maxillary attached gingiva.
We report a case of exuberant brown tumors affecting the gnathic bones as the first manifestation of primary hyperparathyroidism (PHPT). A 34-year-old female patient presented with midfacial asymmetry caused by an 8- × 4-cm painful and bleeding swelling in the left posterior maxilla, showing progressive growth for the last 2 months. A 4- x 2-cm normal-colored swelling was also detected in the right body of the mandible. Medical history included hypertension, fever, and weight loss. Panoramic radiography sh owed multilocular radiolucencies, overall thinning of the inferior border of the mandible, and loss of the lamina dura.
Conclusion This larger set of observational data finds that PPI drugs are associated with an increase in the risk of early death compared with either H2 blockers or no acid suppression drugs. This was the case for participants both with and without gastrointestinal problems. It also appears as though the longer the PPIs drugs are taken, the greater the risk of death. Considering that these drugs are widely used in the UK, these findings may cause concern. But the research has a number of important limitations: The study was conducted in a population of mostly white, older US male veterans, which might limit the abi...