Among patients without known risk factors for iron deficiency, gastric acid inhibitor use for ≥2 years was associated with an increased subsequent risk of iron deficiency. The risk increased with increasing potency of acid inhibition and decreased after medication discontinuation.

itamin B 12 deficiency is relatively common, especially among older adults; it has potentially serious medical complications if undiagnosed. Left untreated, vitamin B 12 deficiency can lead to dementia, neurologic damage, anemia, and other complications, which may be irreversible. According to data from the National Health and Nutrition Examination Survey, 3.2% of adults older than 50 years are estimated to have low serum vitamin B 12 levels. 1 Other studies have reported prevalence rates of 5% to 15%, although these may be underestimates of the true prevalence in some population subgroups. 2,3 Thus, identifying modifiable risk factors for vitamin B 12 deficiency is of significant public health importance. Acid inhibitors are among the most commonly used pharmaceuticals in the United States. In 2012, 14.9 million patients received 157 million prescriptions for proton pump inhibitors (PPIs); thus, use of PPIs could theoretically increase the population's risk of vitamin B 12 deficiency. 4 Gastric acid is required to cleave vitamin B 12 from ingested dietary proteins for the essential vitamins to be absorbed, and it is produced by the same cells that produce intrinsic factor, a compound required for vitamin B 12 absorption. 5 Thus, PPIs and histamine 2 receptor antagonists (H 2 RAs), which suppress the production of gastric acid, may lead to malabsorption of vitamin B 12. IMPORTANCE Proton pump inhibitors (PPIs) and histamine 2 receptor antagonists (H 2 RAs) suppress the production of gastric acid and thus may lead to malabsorption of vitamin B 12. However, few data exist regarding the associations between long-term exposure to these medications and vitamin B 12 deficiency in large population-based studies. OBJECTIVE To study the association between use of PPIs and H 2 RAs and vitamin B 12 deficiency in a community-based setting in the United States. DESIGN, SETTING, AND PATIENTS We evaluated the association between vitamin B 12 deficiency and prior use of acid-suppressing medication using a case-control study within the Kaiser Permanente Northern California population. We compared 25 956 patients having incident diagnoses of vitamin B 12 deficiency between January 1997 and June 2011 with 184 199 patients without B 12 deficiency. Exposures and outcomes were ascertained via electronic pharmacy, laboratory, and diagnostic databases. MAIN OUTCOMES AND MEASURES Risk of vitamin B 12 deficiency was estimated using odds ratios (ORs) from conditional logistic regression. RESULTS Among patients with incident diagnoses of vitamin B 12 deficiency, 3120 (12.0%) were dispensed a 2 or more years' supply of PPIs, 1087 (4.2%) were dispensed a 2 or more years' supply of H 2 RAs (without any PPI use), and 21 749 (83.8%) had not received prescriptions for either PPIs or H 2 RAs. Among patients without vitamin B 12 deficiency, 13 210 (7.2%) were dispensed a 2 or more years' supply of PPIs, 5897 (3.2%) were dispensed a 2 or more years' supply of H 2 RAs (without any PPI use), and 165 092 (89.6%) had not received prescriptions for eithe...

Patients with BE had a persistent excess risk of oesophageal adenocarcinoma over time, although their absolute excess risks for this cancer, any cancer and overall mortality were modest.

Background Blood centers rely heavily upon adolescent donors to meet blood demand, but pre-syncope and syncope are more frequent in younger donors. Studies have suggested administration of water prior to donation may reduce syncope and/or pre-syncope in this group. Study design and methods We conducted a randomized, controlled trial to establish the effect of pre-loading with 500ml of water on the rate of syncope and pre-syncope in adolescent donors. School collection sites in Eastern Cape Province of South Africa were randomized to receive water or not. Incidence of syncope and pre-syncope was compared between randomization groups using multivariable logistic regression. Results Of 2,464 study participants, 1,337 received water and 1,127 did not; groups differed slightly by gender and race. Syncope or pre-syncope was seen in 23 (1.7%) of the treatment and 18 (1.6%) of the control arm subjects. After adjusting for race, gender, age and donation history, there was no difference in outcome between the water versus no water arms (adjusted odds ratio (OR) = 0.80 (95% CI 0.42–1.53). Black donors had 7-fold lower odds of syncope or pre-syncope than their white counterparts (adjusted OR 0.14, 95% CI 0.04–0.47). Conclusion Preloading adolescent donors with 500ml of water did not have a major effect in reducing syncope and pre-syncope in South African adolescent donors. Our adolescent donors had a lower overall syncope and pre-syncope rate than similar populations in the USA, limiting the statistical power of the study. We confirmed much lower rates of syncope and pre-syncope among young Black donors.

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