What is the relationship between peptic ulcer disease and neurocognitive disorder?

From the Guidelines

Patients with peptic ulcer disease and neurocognitive disorder should be managed with a comprehensive approach that addresses both conditions, prioritizing the patient's quality of life and minimizing the risk of complications. When managing peptic ulcer disease in patients with neurocognitive disorder, it is essential to consider the potential interactions between the two conditions.

• The presence of neurocognitive disorder can impact the patient's ability to report symptoms, making regular monitoring crucial to prevent complications such as GI bleeding 1.
• Medication adjustments are necessary to avoid exacerbating the peptic ulcer disease, such as avoiding NSAIDs and using acetaminophen for pain management instead 1.
• Simplifying medication regimens and using pill organizers can improve adherence, and caregivers should be educated about medication administration and signs of GI bleeding 1.
• The connection between peptic ulcer disease and neurocognitive disorder is important to recognize, as anticholinergic medications used for dementia can reduce protective gastric mucus, while stress and altered eating patterns in neurocognitive patients can exacerbate ulcer disease 1. In terms of specific management, a proton pump inhibitor (PPI) such as omeprazole 20mg once daily or pantoprazole 40mg once daily for 4-8 weeks, along with testing for H. pylori infection, is recommended 1.
• If H. pylori is present, triple therapy should be initiated with amoxicillin 1g twice daily, clarithromycin 500mg twice daily, and a PPI twice daily for 14 days 1.
• The patient's quality of life should be regularly assessed, and adjustments made to the treatment plan as needed to minimize the impact of both conditions on daily life 1.

From the Research

Peptic Ulcer Disease and Neurocognitive Disorder

• Peptic ulcer disease is a common condition that affects approximately 1% of the population in the US, with 54,000 patients admitted to the hospital annually for bleeding peptic ulcers 2.
• The principal causes of peptic ulcer disease are Helicobacter pylori infection and aspirin or nonsteroidal anti-inflammatory drug (NSAID) use 2, 3.
• Complications of peptic ulcer disease include bleeding, perforation, and pyloric obstruction, with a mortality rate of 10,000 people per year in the US 2.

Association with Neurocognitive Disorder

• There is evidence to suggest that the use of proton-pump inhibitors (PPIs), commonly used to treat peptic ulcer disease, may be associated with an increased risk of neurocognitive disorders such as Alzheimer's disease 4.
• A study found that chronic use of PPIs can be a risk factor for increased incidence of dementia, including Alzheimer's disease, although the clinical implications of these results are inconclusive 4.
• The molecular mechanisms underlying this association are not fully understood, but may involve modulation of amyloid protein processing 4.

Treatment and Prevention

• Acid blockers, such as omeprazole, can heal peptic ulcers in approximately 80% to 100% of patients within 4 weeks, and eradication of H. pylori can decrease peptic ulcer recurrence rates 2.
• Discontinuing NSAIDs can also heal ulcers and reduce recurrence rates, and changing the NSAID or adding a proton pump inhibitor can reduce recurrence rates when discontinuing an NSAID is not desirable 2.
• PPIs are effective and safe in preventing peptic ulcers and complications in patients requiring NSAID therapy, with no major difference in comparative effectiveness and safety between different PPIs 5.