Effect of long-term acid suppression therapy with proton pump inhibitors or H2 receptor blockers on serum vitamin B12 levels in elderly population

Damodharan, Srinivasan; Raj, Gerard Marshall; Sakthibalan, M; Dakshinamoorthy, Karthikeyan; Muraliswaran, P

doi:10.1007/s11845-020-02399-w

Cited by 4 publications

(3 citation statements)

References 11 publications

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“…However, if the patient is over 65 years of age or is utilizing a high dose of metformin, or is utilizing a proton pump inhibitor or H 2 receptor blockers, or is not African American or has had bariatric surgery or has a haemoglobinopathy associated with a high turnover of red blood cells, hepatic stores would probably be exhausted before 5 years and vitamin B12 levels should be obtained at an earlier time. [21][22][23][24][25][26] When a serum vitamin B12 level is obtained if the vitamin B12 level is above 221 pg/ml, B12 deficiency can be safely ruled out. If the vitamin B12 level is below 148 pg/ml vitamin B12 deficiency is proven and further testing is not necessary.…”

Section: Diagnosing Vitamin B12 Deficiency In Patients Who Are Utiliz...mentioning

confidence: 99%

“…In all patients, the risk of metformin‐induced B12 deficiency, because of the exhaustion of liver stores, increases when metformin utilization has exceeded 5 years. However, if the patient is over 65 years of age or is utilizing a high dose of metformin, or is utilizing a proton pump inhibitor or H 2 receptor blockers, or is not African American or has had bariatric surgery or has a haemoglobinopathy associated with a high turnover of red blood cells, hepatic stores would probably be exhausted before 5 years and vitamin B12 levels should be obtained at an earlier time 21‐26 …”

Section: Diagnosing Vitamin B12 Deficiency In Patients Who Are Utiliz...mentioning

confidence: 99%

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Metformin‐induced vitamin B12 deficiency can cause or worsen distal symmetrical, autonomic and cardiac neuropathy in the patient with diabetes

Bell¹

2022

Diabetes Obesity Metabolism

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Metformin blocks the absorption of vitamin B12 through a mechanism that has not been established but could be because of interference with the calcium-dependent binding of the intrinsic factor vitamin B12 complex to the cubam receptor in the terminal ileum. The subsequent deficiency of vitamin B12 may cause or accelerate distal symmetrical and autonomic neuropathy in the patient with diabetes. Several observational studies and meta-analyses have reported a significant association between metformin utilization and vitamin B12 deficiency. Prospective studies have shown that not only do metformin utilizers have lower vitamin B12 levels but they also have higher frequencies of distal symmetrical polyneuropathy and autonomic neuropathy (including cardiac denervation, which is associated with increased incidences of cardiac arrhythmias, cardiac events and mortality). Therefore, periodic monitoring of vitamin B12 is recommended in all patients who utilize metformin, particularly if metformin has been used for over 5 years at which stage hepatic stores of vitamin B12 would probably be depleted. Factors that accelerate the loss of hepatic vitamin B12 stores are proton pump inhibitors, bariatric surgery, being elderly and having an increased turnover of red blood cells. If serum vitamin B12 levels are borderline, measurement of methylmalonic acid and homocysteine levels can detect vitamin B12 deficiency at its earliest stage. Therapies include prophylactic calcium and vitamin B12 supplements, metformin withdrawal, replenishing vitamin B12 stores with intramuscular or oral vitamin B12 therapy and regular monitoring of vitamin B12 levels and vitamin B12 supplements if metformin continues to be utilized. With adequate vitamin B12 replacement, while symptoms of neuropathy may or may not improve, objective findings of neuropathy stabilize but do not improve.

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Section: Diagnosing Vitamin B12 Deficiency In Patients Who Are Utiliz...mentioning

confidence: 99%

Section: Diagnosing Vitamin B12 Deficiency In Patients Who Are Utiliz...mentioning

confidence: 99%

Metformin‐induced vitamin B12 deficiency can cause or worsen distal symmetrical, autonomic and cardiac neuropathy in the patient with diabetes

Bell¹

2022

Diabetes Obesity Metabolism

View full text Add to dashboard Cite

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“…This statement is supported by some systematic reviews and meta-analyses [ 7 , 8 ] as well as a substantial number of population-based studies conducted in which data accounts for the increased risk of vitamin B12 deficiency in patients who take PPIs at rates of 1.5 pills per day for more than 2 years [ 9 ]. Acid suppression therapy encompasses a wide range of drugs, including H2 receptor blockers as well as PPIs that cause Vitamin B12 deficiency, regardless of whether the agents are of the same class or different [ 10 ]. Considering the time duration, multiple studies demonstrate different results than those expected.…”

Section: Introductionmentioning

confidence: 99%