Effect of long-term proton pump inhibitor therapy on hemoglobin and serum iron levels after sleeve gastrectomy

Sharma, Nitin; Chau, Wai Yip; Dobruskin, Lisa

doi:10.1016/j.soard.2019.06.019

Cited by 9 publications

(15 citation statements)

References 30 publications

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“…A pooled analysis of metastatic RCC patients treated with various vascular endothelial growth factor TKIs demonstrated that PPI use did not appear to negatively affect efficacy [ 25 ]. Although decreased efficacy of erlotinib with concomitant use of ARAs was controversially reported in several studies [ 26 , 27 ], the increasing number of analyses suggesting an absence of PFS and OS reduction with concomitant PPI use raises the question of whether PPI contraindication is warranted if a change in exposure is found in dedicated healthy volunteer studies.…”

Section: Discussionmentioning

confidence: 99%

Evaluation of the Effect of Proton Pump Inhibitors on the Efficacy of Dacomitinib and Gefitinib in Patients with Advanced Non-Small Cell Lung Cancer and EGFR-Activating Mutations

Nickens

Wilner

et al. 2021

Oncol Ther

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Introduction: Dacomitinib and gefitinib are irreversible epidermal growth factor receptor (EGFR) tyrosine kinase inhibitors (TKI) indicated for the first-line treatment of patients with advanced non-small cell lung cancer (NSCLC) and EGFR-activating mutations. Pharmacokinetic (PK) studies in healthy volunteers suggested that acid-reducing drugs such as proton pump inhibitors (PPI) decreased dacomitinib and gefitinib exposure by limiting the pH-dependent absorption. This analysis retrospectively evaluates the effect of concomitant PPI use on dacomitinib exposure and on progression-free survival (PFS) and overall survival (OS) in patients treated with dacomitinib 45 mg QD or gefitinib 250 mg QD in a 1:1 randomized phase 3 study (ARCHER 1050). Methods: The analysis grouped all patients (n = 452) treated in each arm of the study as non-PPI users, PPI users, or extensive PPI users. PFS and OS data were presented by Kaplan--Meier plots and analyzed using Cox proportional hazards models. Dacomitinib exposure was compared using a linear mixed-effects model. Results: Results showed that dacomitinib PFS and OS did not differ significantly when comparing PPI users (N = 59) to non-PPI users (N = 152), while extensive PPI users (N = 24) had shorter PFS [hazard ratio (HR): 1.94, p = 0.011] and OS (HR: 1.77, p = 0.027) when compared to non-PPI users. For patients treated with gefitinib, PFS did not differ significantly when comparing PPI users (N = 51) and extensive PPI users (N = 19) to non-PPI users (N = 159); however, both PPI users (HR: 1.65, p = 0.007) and extensive PPI users (HR: 1.70, p = 0.050) had shorter OS when compared to non-PPI users. Further analysis by adjusting potential confounders indicated no statistically significant differences in PFS or OS between any PPI user vs. non-PPI user groups in the dacomitinib and gefitinib arms. PPI use did not appear to affect dacomitinib exposure. Conclusion:In conclusion, PPI use in patients with NSCLC likely has minimal impact on dacomitinib or gefitinib efficacy despite

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Section: Discussionmentioning

confidence: 99%

Evaluation of the Effect of Proton Pump Inhibitors on the Efficacy of Dacomitinib and Gefitinib in Patients with Advanced Non-Small Cell Lung Cancer and EGFR-Activating Mutations

Nickens

Wilner

et al. 2021

Oncol Ther

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“…Other risk factors for developing anemia include female sex, younger age, poor preoperative iron status, vitamin B12 deficiency, and postoperative longevity (Table 1). 12,13 Iron deficiency typically is more prevalent in all women of childbearing age, which might be explained by menstrual loss 12…”

Section: Iron Deficiency Risk Factorsmentioning

confidence: 99%

“…Patients who have had bariatric surgery, particularly laparoscopic sleeve gastrectomy, often experience postoperative reflux symptoms 13. Patients also may develop marginal ulcers caused by anemia, smoking, or use of anti-inflammatory medications or other prescription medications 17.…”

Section: Concurrent Ppi Usementioning

confidence: 99%

Oral iron replacement vs. IV iron treatment in bariatric surgery patients with anemia

Connors¹,

Watkins²

2023

Jaapa

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besity rates in the United States and globally are steadily increasing. The World Health Organization (WHO) estimates that since 1975, obesity rates globally have nearly tripled. 1 Worldwide in 2016, nearly 2 billion adults were overweight, and of those, 650 million were obese. 1 In the United States, the obesity rate was 39.8% in 2015-2016, and among adults, the rate was 42.8% for those ages 40 to 59 years. 2 Multiple factors infl uence obesity, including environment, lifestyle, stress and other emotional factors, genetics, race, and endocrine factors. 3 Obesity has been linked to multiple medical conditions such as type 2 diabetes, hypertension, stroke, obstructive sleep apnea (OSA), cardiac disease, and cancer. 4 Most patients with morbid obesity have tried multiple diets without long-term success. Lifestyle changes can result in a 2% to 6% weight loss, but almost 90% of patients will have regained the weight in 1 to 5 years. 5 As such, many patients consider bariatric surgery as a tool to reduce weight and improve or resolve comorbid conditions asso-

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“…Treatment of eight such patients [305] with PPIs decreased serum ferritin and reduced mean hemoglobin levels led the authors to conclude it was reducing iron overabsorption and my lower the need for chelation therapy. A third study reported the effect of chronic PPI treatment of patients after sleeve gastrectomies, who frequently develop iron deficiency anemia post-surgery [306]. The PPI-treated patients ( n = 85) compared to a group not taking PPIs ( n = 118) had a 3.3-fold higher incidence of iron deficiency anemia [306].…”

Section: Insights Of Effects Of Chronic Hypergastrinemia In Patienmentioning

confidence: 99%

“…A third study reported the effect of chronic PPI treatment of patients after sleeve gastrectomies, who frequently develop iron deficiency anemia post-surgery [306]. The PPI-treated patients ( n = 85) compared to a group not taking PPIs ( n = 118) had a 3.3-fold higher incidence of iron deficiency anemia [306]. In a fourth study [307], a retrospective study of patients with iron deficiency anemia taking PPIs ( n = 50) was performed in which they assessed the hematological response to ferrous sulfate treatment.…”

Section: Insights Of Effects Of Chronic Hypergastrinemia In Patienmentioning

confidence: 99%

Insights into Effects/Risks of Chronic Hypergastrinemia and Lifelong PPI Treatment in Man Based on Studies of Patients with Zollinger–Ellison Syndrome

Lee

Ramos-Álvarez

Ito

et al. 2019

IJMS

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The use of proton pump inhibitors (PPIs) over the last 30 years has rapidly increased both in the United States and worldwide. PPIs are not only very widely used both for approved indications (peptic ulcer disease, gastroesophageal reflux disease (GERD), Helicobacter pylori eradication regimens, stress ulcer prevention), but are also one of the most frequently off-label used drugs (25–70% of total). An increasing number of patients with moderate to advanced gastroesophageal reflux disease are remaining on PPI indefinitely. Whereas numerous studies show PPIs remain effective and safe, most of these studies are <5 years of duration and little data exist for >10 years of treatment. Recently, based primarily on observational/epidemiological studies, there have been an increasing number of reports raising issues about safety and side-effects with very long-term chronic treatment. Some of these safety issues are related to the possible long-term effects of chronic hypergastrinemia, which occurs in all patients taking chronic PPIs, others are related to the hypo-/achlorhydria that frequently occurs with chronic PPI treatment, and in others the mechanisms are unclear. These issues have raised considerable controversy in large part because of lack of long-term PPI treatment data (>10–20 years). Zollinger–Ellison syndrome (ZES) is caused by ectopic secretion of gastrin from a neuroendocrine tumor resulting in severe acid hypersecretion requiring life-long antisecretory treatment with PPIs, which are the drugs of choice. Because in <30% of patients with ZES, a long-term cure is not possible, these patients have life-long hypergastrinemia and require life-long treatment with PPIs. Therefore, ZES patients have been proposed as a good model of the long-term effects of hypergastrinemia in man as well as the effects/side-effects of very long-term PPI treatment. In this article, the insights from studies on ZES into these controversial issues with pertinence to chronic PPI use in non-ZES patients is reviewed, primarily concentrating on data from the prospective long-term studies of ZES patients at NIH.

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Effect of long-term proton pump inhibitor therapy on hemoglobin and serum iron levels after sleeve gastrectomy

Cited by 9 publications

References 30 publications

Evaluation of the Effect of Proton Pump Inhibitors on the Efficacy of Dacomitinib and Gefitinib in Patients with Advanced Non-Small Cell Lung Cancer and EGFR-Activating Mutations

Evaluation of the Effect of Proton Pump Inhibitors on the Efficacy of Dacomitinib and Gefitinib in Patients with Advanced Non-Small Cell Lung Cancer and EGFR-Activating Mutations

Oral iron replacement vs. IV iron treatment in bariatric surgery patients with anemia

Insights into Effects/Risks of Chronic Hypergastrinemia and Lifelong PPI Treatment in Man Based on Studies of Patients with Zollinger–Ellison Syndrome

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