Iron-deficiency Anemia Caused by a Proton Pump Inhibitor

Abstract

A 59-year-old man was orally administered rabeprazole, a proton pump inhibitor (PPI), for gastroesophageal reflux disease, after which he gradually developed iron-deficiency anemia. The anemia did not improve following the administration of ferrous fumarate, and endoscopic screening of the entire gastrointestinal tract, including the small intestine, did not reveal any findings indicating the cause of the anemia. The patient was then switched from rabeprazole to famotidine and the anemia was cured within three months. There is much debate as to whether the long-term use of PPIs causes iron-deficiency. However, this case strongly suggests that PPIs can induce iron-deficiency anemia.

A Case of Severe Iron Deficiency Anemia Associated with Long-Term Proton Pump Inhibitor Use

“…The Naranjo Adverse Drug Reaction Probability Scale and the Horn and Hansten Drug Interaction Probability Scale are both suggestive of an association between long-term PPI use and the observed iron deficiency anemia (scores of 5 and 6, respectively); however, the patient’s untimely death prevented confirmatory follow-up data from being obtained to confirm long-term PPI use as the culprit. Repeat lab work 3 months after cessation of omeprazole was planned to confirm recovery, as occurred in cases previously described [3], [5]…”

“…There are 2 types of dietary iron: (1) the heme type derived from animal blood and muscle and (2) the more common nonheme type derived from plants, fruits, vegetables, grains, and nuts. Accounting for ~10% of the Western diet, the heme type is absorbed independently of gastric pH, whereas the nonheme component requires an acidic pH for absorption 3 . There are few case reports of iron deficiency induced by long-term omeprazole use and the effect of omeprazole on iron replacement therapy [3], [4], [5].…”

“…Accounting for ~10% of the Western diet, the heme type is absorbed independently of gastric pH, whereas the nonheme component requires an acidic pH for absorption 3 . There are few case reports of iron deficiency induced by long-term omeprazole use and the effect of omeprazole on iron replacement therapy [3], [4], [5]. In contrast, Koop and Bachem 6 concluded that iron and ferritin malabsorption was unlikely to occur during the first 3 to 4 years of omeprazole therapy.…”

Case report of severe iron deficiency anemia caused by proton pump inhibitor in an elderly patient

“…1 However, PPI rarely cause clinically significant iron deficiency anemia. [7][8][9] To our knowledge, this is the first report of PPI-induced iron deficiency anemia that was severe enough to warrant a blood transfusion. Both atrophic gastritis and lansoprazole might have acted synergistically to decrease iron absorption, which resulted in anemia.…”

Iron deficiency anaemia due to proton pump inhibitors: clinical impact revealed

“…Studies have shown that the problem ceases when PPI therapy is discontinued or replaced by the use of an H 2 ‐receptor antagonist , but treatment of ID in situations in which continued PPI therapy is required has been poorly studied. Intravenous iron therapy should be avoided.…”