Cognition, oxidative stress and vitamin B12 levels evaluation on patients under long-term omeprazole use

Abstract

Objectives To evaluate the differences concerning cognitive performance, oxidative stress and vitamin B12 levels in omeprazole users under treatment for longer than six months. Methods A case-control study was developed with 44 omeprazole users (OU; 81.8 % female, 66 ± 8.7 years old) and 35 nonusers (NOU; 88.6 % female, 62 ± 8.7 years old). The cognitive ability was assessed through tests approaching attention, memory and executive functions. The vitamin B12 was dosage using a chemiluminescent immunoassay and oxidative stress analysis, based on the evaluation of malondialdehyde, enzymatic activity of extracellular superoxide dismutase, glutathione peroxidase, catalase and the ferric reducing antioxidant power in plasma. Key findings A significant increase of the ferric reducing antioxidant power [omeprazole users (OU) group = 1690 µM ± 441 and nonusers (NOU) group = 1308 ± 616; P value=0.002] and a decrease on glutathione peroxidase levels [OU group = 0.534 (0.27–10.63) and NOU group = 71.86 (14.36–173.1); P value=0.006] were found on omeprazole users group, as well as differences on cognitive performance, with impairments on executive functions, automatic and attentional processing. Conclusions Long-term use of omeprazole is suggested to induce an oxidative stress condition, which causes neurotoxicity and cognitive decline.

Chronic use of proton pump inhibitors and vitamin B12 deficiency: Current evidence and recommendations

“…It is foreseeable, therefore, that a stomach in achloridia, resulting from the prolonged use of PPIs, will make it impossible to extract VB12 from the food matrix, with its availability for absorption in the ileum decreased (Damodharan et al, 2021). These theoretical aspects are reinforced by several populationbased studies already conducted (Porter et al, 2021;Dries et al, 2022).…”

“…Even the use of IPBs for relatively short periods of six months can cause clinical manifestations of vitamin B12 deficiency via oxidative stress, including neurotoxicity and cognitive decline (Dries et al, 2022).…”

Proton pump inhibitors display anti‐tumour potential in glioma

“…It has been proved that PPIs elevate the pH of the stomach and upper gut causing more bacteria, even pathogenic bacteria, to survive in the gastrointestinal tract and enter the gut gradually 314 . Vitamin B12, vitamin C, vitamin D, magnesium, calcium, iron, β‐carotene and zinc will be reduced due to the decreased relative quality of food release and body absorption 315–319 . Suppressing magnesium may inhibit the absorption of Vitamin D implying the release of adipocytokine which is involved in the regulation of glucose levels and fatty acid breakdown inducing insulin resistance so that the appearance of obesity and contribute to an increase of the inflammatory state 315 .…”

“… 314 Vitamin B12, vitamin C, vitamin D, magnesium, calcium, iron, β‐carotene and zinc will be reduced due to the decreased relative quality of food release and body absorption. 315 , 316 , 317 , 318 , 319 Suppressing magnesium may inhibit the absorption of Vitamin D implying the release of adipocytokine which is involved in the regulation of glucose levels and fatty acid breakdown inducing insulin resistance so that the appearance of obesity and contribute to an increase of the inflammatory state. 315 Based on a reported real case, PPIs may be associated with several mental diseases.…”

Association of Vitamin B12 deficiency with long-term PPIs use: A cohort study

“…Considering the time duration, multiple studies demonstrate different results than those expected. PPIs such as Omeprazole, if used for more than 6 months can cause Vitb12 deficiency clinical manifestations including Neurotoxicity and cognitive decline by oxidative stress mechanisms [ 11 ].…”