Proton pump inhibitors block iron absorption through direct regulation of hepcidin via the aryl hydrocarbon receptor-mediated pathway

Hamano, Hirofumi; Niimura, Takahiro; Horinouchi, Yuya; Zamami, Yoshito; Takechi, Kenshi; Goda, Mitsuhiro; Imanishi, Masaki; Chuma, Masayuki; Izawa‐Ishizawa, Yuki; Miyamoto, Licht; Fukushima, Keijo; Fujino, Hiromichi; Tsuchiya, Koichiro; Ishizawa, Keisuke; Takahashi, Toshiaki; Ikeda, Yasumasa

doi:10.1016/j.toxlet.2019.10.016

Cited by 30 publications

(30 citation statements)

References 17 publications

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“…Hepcidin degrades ferroportin and when hepcidin levels increase, the absorption of iron through the small intestine is decreased. Experimentally, omeprazole has been shown to upregulate hepcidin levels and downregulate ferroportin, providing an additional mechanism through which omeprazole could inhibit iron absorption in certain individuals [ 8 ].…”

Section: Discussionmentioning

confidence: 99%

An Unusual Presentation of Iron-Deficiency Anemia: An Autobiographical Case Report

Kobets¹,

Kobets²

2021

Cureus

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Gastroesophageal reflux disease (GERD) is one of the most common gastrointestinal disorders and the use of proton-pump inhibitors has become the mainstay of treatment for many patients. While these are the most effective medications for the management of GERD, there are several side effects that patients may experience with their use. This autobiographical case report describes the development of iron-deficiency anemia (IdA) with chronic use of omeprazole. The patient was a 35-year-old male with a history of essential hypertension and GERD who was taking omeprazole 40 mg daily for 3 years for the management of reflux symptoms. He developed some mild exercise intolerance and began noticing an affinity for unusual smells, including gasoline and dust, which prompted an evaluation. Lab work demonstrated IdA to 8.3 g/dl, which was not corrected by oral iron supplementation. Sources of gastrointestinal bleeding, Helicobacter pylori infection, and other hypersecretion syndromes were ruled out. IV iron response was transient and only after 8 months of discontinuation of omeprazole did the anemia correct on its own. Omeprazole has increasingly become recognized as a cause of IdA, but only three clinical case reports have been documented in the literature. At least two mechanisms may be involved, and the discontinuation of omeprazole may correct the anemia in 2 months in mild cases, but up to 8 months in more severe cases. The presence of an abnormal propensity for unusual smells, similar to pica as seen in other IdAs, was a unique feature of this case and should prompt evaluation.

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Section: Discussionmentioning

confidence: 99%

An Unusual Presentation of Iron-Deficiency Anemia: An Autobiographical Case Report

Kobets¹,

Kobets²

2021

Cureus

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“…Darüber hinaus könnte auch die durch PPI induzierte erhöhte Belastung mit Helicobacter pylori die alimentäre Verfügbarkeit des Mineralstoffs stören. Darüber hinaus ist eine direkte Interaktion der PPI mit der Hepcidin-Ferroportin-Achse beschrieben 20 21 22 .…”

Section: Wichtig: Der Einsatz Von Ppi üBer Eine Dauer Von 8 Wochen Hi...unclassified

Protonenpumpenhemmer (PPI): Mikronährstoff-Räuber mit nachhaltigen Nebenwirkungen (Teil 1)

Gröber¹

2022

Zeitschrift für Orthomolekulare Medizin

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ZusammenfassungDie längerfristige Einnahme von Protonenpumpeninhibitoren (PPI) ist mit zahlreichen Risiken verbunden, daher ist der Einsatz der Säureblocker möglichst auf max. 8 Wochen zu begrenzen. Aufgrund der verringerten Magensäureproduktion unter PPI siedeln sich vermehrt pathogene Bakterien im Gastrointestinaltrakt an, es kommt zu verminderter Resorption und Utilisation von Mikronährstoffen wie Magnesium, Kalzium, Zink, Eisen und Vitamin B12. Eine Reihe von miteinander vernetzten Pathomechanismen erhöht das Osteoporose- bzw. Frakturrisiko deutlich. Erste Studien weisen darauf hin, dass die dauerhafte Blockade der Magensäure das Risiko für eine Infektion mit SARS-CoV-2 als auch die Schwere des Krankheitsverlaufs steigert. Die Verabreichung von PPI im 1. Trimenon der Schwangerschaft scheint nicht mit einem teratogenen Risiko verbunden zu sein, im Gegensatz zur Einnahme in den 4 Wochen vor der Konzeption. Die Einnahme während der Gravidität erhöht das Risiko für kindliches Asthma und Allergien.

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“…Long-term use (> 1 year) of PPIs has been reported to increase the risk of an iron deficiency; therefore, it is recommended to monitor iron deficiency symptoms during prolonged PPI regimens [29]. Interestingly, PPIs have been demonstrated to decrease iron absorption via inhibition of intestinal ferroportin by upregulating hepcidin [30]. Another consideration is that in a deficiency of both Fe and folate, the hematological changes will likely be unclear.…”

Section: Possible Mechanisms For Nutritional Deficiencies Associamentioning

confidence: 99%

Nutritional Deficiencies Associated with Gastroesophageal Reflux Disease (GERD) in Elderly/Older Adults

Burns‐Whitmore¹,

Froyen²

2020

GGR

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Introduction: Gastroesophageal reflux disease (GERD) is the most common upper gastrointestinal disorder encountered in the elderly patient. GERD is one of the highly prevalent diseases seen in the clinical practice. In the elderly population, few studies have addressed the prevalence of GERD. It is estimated that 20-30% of the US population experience weekly symptoms of GERD, and two out of five people experience heartburn or acid regurgitation at least once a month. Methods: To ensure peer-review articles were used, the search engine, PubMed was utilized along with medical reference-related websites and US Department websites as well as professional organizations. Some medications used by older adults may promote acid reflux, prescription treatments include proton pump inhibitors (PPIs), coating agents, H2 blockers and over-the-counter medications that contain antacids or decreased dosages of the prescription strength H2 blockers and PPIs. Discussion: Decreased stomach acidity could be responsible for risk of nutrient deficiencies including vitamin B12 (cobalamin), vitamin C (ascorbate), calcium, iron and magnesium deficiencies or medications that are used to alleviate the symptoms of GERD may also be responsible for increasing the risk for deficiencies. The purpose of this review is to demonstrate and provide reasons why regular assessment, screening, testing, and/or clinically evaluating nutritional deficiencies common in older adults and relating to physical pathogenesis and/or drug treatments of GERD, should be added to the GERD treatment protocol for older adults.

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Proton pump inhibitors block iron absorption through direct regulation of hepcidin via the aryl hydrocarbon receptor-mediated pathway

Cited by 30 publications

References 17 publications

An Unusual Presentation of Iron-Deficiency Anemia: An Autobiographical Case Report

An Unusual Presentation of Iron-Deficiency Anemia: An Autobiographical Case Report

Protonenpumpenhemmer (PPI): Mikronährstoff-Räuber mit nachhaltigen Nebenwirkungen (Teil 1)

Nutritional Deficiencies Associated with Gastroesophageal Reflux Disease (GERD) in Elderly/Older Adults

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