LAUSR

To the Editor: I have read the article of Ho and colleagues with great interest. They found that individuals with dementia are more prone to develop pneumonia when using long-term proton pump inhibitors (PPIs) than those not using PPIs. One of the major long-term complications of prolonged use of PPIs is pneumonia, and it is seen not only in individuals with dementia but also in all populations using long-term PPIs. I have carefully read the article, and I wonder if it is possible to add or explain some points to enhance the findings of the article. First, one of the most-common reasons for pneumonia in individuals with dementia is related to difficulty swallowing. Although dysphagia rates of individuals using PPIs and controls are available and seem to be similar between groups in a recent study, it is not clearly described whether participants’ swallowing problems were investigated using a validated swallowing test. The other point that should be considered when evaluating respiratory infections is pneumococcus and influenza vaccination rates in the study population. I wonder if the mentioned vaccines rates in the study population are available according to group. Lastly, we encounter the problem in daily clinical practice of long-term use of PPIs that, in most individuals using PPIs, there is no absolute risk for gastric protection, so I wonder if it is possible to know the indications for using PPIs in recent study populations and whether the indications are similar between patient groups.