Use of proton pump inhibitors and risk of iron deficiency: a population‐based case–control study

Abstract

Chronic PPI use increases the risk of ID. Physicians should consider this when balancing the risks and benefits of chronic PPI prescription.

Iron deficiency anemia associated with extracorporeal photopheresis: A retrospective analysis

“…In our univariate Cox proportional hazards models, PPI use and solid organ transplantation were identified as risk factors for development of IDA during ECP therapy, while heparin use (over citrate) was associated with reduced risk. Iron absorption is partially dependent on acidic pH, and as PPIs can induce a hypo‐ or achlorhydric state, chronic PPI use has been implicated in the development of iron deficiency . The potential for diminished gastrointestinal absorption, coupled with presumed iron loss from ECP therapy, may explain why PPI use was identified as a risk factor for IDA in our cohort.…”

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

“…An older, small cohort study of the effects of 1 year of PPI therapy in cases versus controls yielded ORs of 5.03 for a decrease in haemoglobin, and of 5.46 for a fall in haematocrit; this was a PPI class effect . The recent large studies showed that the risks reached a plateau at a medium dose and at a duration of use of 2 years , and improved when PPI use was discontinued. Risks were similar during time periods when PPIs were available solely by prescription or when PPIs were also available over the counter .…”

“…For over a decade, despite animal and human studies and numerous case reports that demonstrated interference by proton pump inhibitors (PPIs) with enteric absorption of dietary and medicinal iron, the importance of this effect in clinical practice has remained uncertain . With the publication in this issue of a large, well‐controlled, UK‐based population study , strongly supported by another similarly large study from the USA , the risks of PPI‐induced iron deficiency (ID) have been definitively established. The UK database study, by authors from the Netherlands, showed that in full (continuous for >1 year) and partial (intermittent) long‐term users of PPIs, adjusted odds ratios (ORs) for developing ID compared to non‐users were approximately 3.6 and 1.5, respectively.…”

“…In one study of 50 iron‐deficient patients, in the presence of co‐therapy with omeprazole 40 mg daily, the response to oral ferrous sulphate was suboptimal . In efforts to avoid any possible confounding, the authors of the large US study excluded most cases with any possible cause of ID (19 cases) and the large UK database study individually analyzed six groups of covariates, comprising almost 40 disease states associated with ID ; adjusting for these variables did not have any major effect on the final adjusted OR. However, whether PPI use could delay or impair the response to iron therapy in states in which the PPI was not the original or sole cause of ID anaemia (e.g.…”

“…an iron‐deficient diet or chronic blood loss) remains unknown. Thus PPI therapy may adversely affect ID anaemia, regardless of cause, even when the dose used is at or below 1 DDD for ≥6 months .…”