Proton Pump Inhibitor and Histamine 2 Receptor Antagonist Use and Vitamin B₁₂Deficiency

Abstract

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...

Déficit de vitamina B12 asociado al consumo de inhibidores de la bomba de protones

“…Las personas con un consumo de IBP mayor de 3 años presentaron niveles más bajos de vitamina B 12 , y este hallazgo es similar a estudios previamente publicados (8). La deficiencia de B 12 (menor de 200 pg/mL) fue más frecuente en los pacientes con un consumo de IBP mayor de 3 años, frente a quienes lo habían utilizado durante 3 años o menos.…”

“…El uso a largo plazo de los IBP es eficaz y seguro. Sin embargo, hay evidencia sugestiva respecto de que su empleo a largo plazo puede producir disminución de los niveles séricos de B 12 (4,5,6,7,8).…”

Living with Hemoglobin of 3.7 After Bariatric Surgery! Follow-up is Key to Preventing Adverse Outcomes

“…Iron is absorbed in the duodenum and proximal jejunum; alteration in anatomy, along with post-surgery achlorhydria, can impair iron absorption. The common practice of prophylactic use of H2 blockers and proton pump inhibitors to reduce acid secretion can interfere with iron and B12 absorption [19][20]23]. Consumption of iron rich food, such as red meat, may decline following surgery due to altered food preferences, worsening the predisposition to iron deficiency.…”

Practical considerations in the management of proton-pump inhibitors

“…In the case of vitamin B 12 , most of the studies are case-control and many of them have been questioned because the method of measurement of vitamin B 12 is not taking into account the patient's diet (29,30). Furthermore, studies of low methodological consistency have associated PPI for over a year with hypomagnesaemia (31,32).…”