Iron Deficiency Anemia Due to the Long-term Use of a Proton Pump Inhibitor

Imai, Ryosuke; Higuchi, Takakazu; Morimoto, Masaharu; Koyamada, Ryosuke; Okada, Sadamu

doi:10.2169/internalmedicine.9554-17

Cited by 22 publications

(11 citation statements)

References 10 publications

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“… 31 Finally, the chronic consumption of certain drugs such as PPIs and aging has also been implicated in AID through reduced stomach acid secretion resulting in a decrease in intestinal iron absorption. 2 , 28 , 37 For PPIs, it is especially true for non-heme iron. 20 This mechanism is also described in pernicious anemia and achlorhydria (reducing iron absorption due to the non-solubilization of non-heme iron) which are associated with gastric atrophy, causing vitamin B 12 deficiency.…”

Section: Conditions That Can Affect the Amount Of Iron In The Human Bmentioning

confidence: 99%

<p>Iron in the General Population and Specificities in Older Adults: Metabolism, Causes and Consequences of Decrease or Overload, and Biological Assessment</p>

Manckoundia

Konaté

Hacquin

et al. 2020

CIA

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Iron is involved in many types of metabolism, including oxygen transport in hemoglobin. Iron deficiency (ID), ie a decrease in circulating iron, can have severe consequences. We provide an update on iron metabolism and ID, highlighting the particularities in older adults (OAs). There are three iron compartments in the human body: 1) the functional compartment, which consists of heme proteins including hemoglobin, myoglobin and respiratory enzymes; 2) iron reserves (IR), which consist mainly of liver stocks and are stored as ferritin; and 3) transferrin. There are two types of ID. Absolute ID is characterized by a decrease in IR. Its main pathophysiological mechanism is bleeding, which is often digestive and can be due to neoplasia, frequent in OAs. Biological assessment shows low serum ferritin and transferrin saturation (TS) levels. Furthermore, hypochromic microcytic anemia is frequent, and the serum-soluble transferrin receptor (sTfR) level is high. Functional ID, in which IR are high or normal, is due to inflammation, which is also frequent in OAs, particularly in its chronic form. Biological assessments show high serum ferritin, normal or low TS, and normal sTfR levels. Moreover, C-reactive protein is elevated, and there is moderate non-regenerative non-macrocytic anemia. The main characteristics of iron metabolism anomalies in the elderly are the high frequency of ID (20% of ID with anemia in adults ≥85 years) and the severity of its consequences, which include cognitive impairment in case of ID or iron overload and decrease of physical activity in case of ID. In conclusion, causes of ID are frequently intertwined in OAs as a result of the polymorbidity that characterizes them. ID can have dramatic consequences, especially in frail OAs. Thus, measuring the appropriate biological markers prevents errors in the positive diagnosis of ID type, clarifies etiology, and informs treatment-related decision-making.

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Section: Conditions That Can Affect the Amount Of Iron In The Human Bmentioning

confidence: 99%

<p>Iron in the General Population and Specificities in Older Adults: Metabolism, Causes and Consequences of Decrease or Overload, and Biological Assessment</p>

Manckoundia

Konaté

Hacquin

et al. 2020

CIA

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“…The low or absence of HCL acid in gastric secretions is called achlorhydria. Proton pump inhibitors (PPI) and H2 blockers can impair the iron absorption since they decrease the HCL when used in the long term [39,40]. NSAIDs cause gastric mucosal inflammation, which leads to low iron absorption [41,42].…”

Section: Decreased Iron Absorptionmentioning

confidence: 99%

Iron and Iron Deficiency Anemia - A Review

Dhakal¹,

kunwar²,

Liu³

et al. 2020

IJAR

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Anemia is defined as the hemoglobin (Hb) of less than 12g/dL (120g/L) in women and less than 13g/dL (130g/L) in men [1]. Globally, ID is the most frequent form of anemia and the leading cause of microcytic hypochromic anemia. About 50% of cases of anemia are due to ID and nearly a million deaths annually worldwide [2, 3]. Approximately 2-5% of post-menopausal women and adult men are suffered from ID in the developed world and leading cause being the chronic blood loss from the GI tract [4]. IDA incidence is significantly high in childbearing

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“…Reduced protein intake secondary to decreased appetite and adherence to low-protein diets can result in reduced iron available for absorption [4]. Concomitant use of certain medications, such as proton pump inhibitors, can inhibit absorption of iron by enterocytes, further contributing to iron deficiency [23, 24]. …”

Section: Alterations In Iron Homeostasis Associated With Ckdmentioning

confidence: 99%

Positive Iron Balance in Chronic Kidney Disease: How Much is Too Much and How to Tell?

et al. 2018

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Background: Regulation of body iron occurs at cellular, tissue, and systemic levels. In healthy individuals, iron absorption and losses are minimal, creating a virtually closed system. In the setting of chronic kidney disease and hemodialysis (HD), increased iron losses, reduced iron absorption, and limited iron availability lead to iron deficiency. Intravenous (IV) iron therapy is frequently prescribed to replace lost iron, but determining an individual’s iron balance and stores can be challenging and imprecise, contributing to uncertainty about the long-term safety of IV iron therapy. Summary: Patients on HD receiving judicious doses of IV iron are likely to be in a state of positive iron balance, yet this does not appear to confer an overt risk for clinically relevant iron toxicity. The concomitant use of iron with erythropoiesis-stimulating agents, the use of maintenance iron dosing regimens, and the reticuloendothelial distribution of hepatic iron deposition likely minimize the potential for iron toxicity in patients on HD. Key Messages: Because no single diagnostic test can, at present, accurately assess iron status and risk for toxicity, clinicians need to take an integrative approach to avoid iron doses that impose excessive exposure while ensuring sufficient replenishment of iron stores capable of overcoming hepcidin blockade and allowing for effective erythropoiesis.

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Iron Deficiency Anemia Due to the Long-term Use of a Proton Pump Inhibitor

Cited by 22 publications

References 10 publications

<p>Iron in the General Population and Specificities in Older Adults: Metabolism, Causes and Consequences of Decrease or Overload, and Biological Assessment</p>

<p>Iron in the General Population and Specificities in Older Adults: Metabolism, Causes and Consequences of Decrease or Overload, and Biological Assessment</p>

Iron and Iron Deficiency Anemia - A Review

Positive Iron Balance in Chronic Kidney Disease: How Much is Too Much and How to Tell?

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