Proton Pump Inhibitors and Dementia Incidence

To the Editor In their recent publication, Gomm et al¹ found that regular proton pump inhibitor (PPI) use was associated with a 44% increased risk for dementia based on claims data from a large German health insurer. The authors concluded that avoidance of PPI use may prevent the development of dementia. In addition to the established uncertainty inherent to claims data analyses² and limitations of inferring causation based on observational data, we believe the design of the multivariable analysis did not adequately account for confounding by medication use.