Serum magnesium and proton-pump inhibitors use: a cross-sectional study

Faulhaber, Gustavo Adolpho Moreira; Ascoli, Bruna Maria; Lubini, Adriano; Mossmann, Márcio; Rossi, Gabriela; Geib, Guilherme; Furlanetto, Tânia Weber

doi:10.1016/j.ramb.2012.12.007

Cited by 26 publications

(23 citation statements)

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“…Gau et al 18 Koulouridis et al 24 Kim et al 19 Faulhaber et al 29 Danziger et al with a low intake of Mg, GI malabsorption disorders or an increased renal loss of Mg due to diuretic use. Although, almost all included studies were of moderate to high quality (as evaluated by Newcastle-Ottawa scale) and we also confirmed the result by sensitivity analysis in only high quality studies, 5,18,20,24 there are some limitations.…”

Section: Discussionmentioning

confidence: 99%

“…Nine observational studies 5,[18][19][20][21][22][23][24]29 (three cohort studies, five cross-sectional study and a case control study) with a total of 109,798 patients were included in the data analysis for the risk of hypomagnesemia in patients with PPI use. Table 1 describes the detailed characteristics and quality assessment of the included studies.…”

Section: The Risk Of Hypomagnesemia In Patients With Ppi Usementioning

confidence: 99%

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Proton pump inhibitors linked to hypomagnesemia: a systematic review and meta-analysis of observational studies

et al. 2015

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Background: The reported risk of hypomagnesemia in patients with proton pump inhibitor (PPI) use is conflicting. The objective of this meta-analysis was to assess the association between the use of PPIs and the risk of hypomagnesemia. Methods: A literature search of observational studies was performed using MEDLINE, EMBASE and Cochrane Database of Systematic Reviews from inception through September 2014. Studies that reported odd ratios or hazard ratios comparing the risk of hypomagnesemia in patients with PPI use were included. Pooled risk ratios (RRs) and 95% confidence interval (CI) were calculated using a random-effect, generic inverse variance method. Results: Nine observational studies (three cohort studies, five crosssectional studies and a case-control study) with a total of 109,798 patients were identified and included in the data analysis. The pooled RR of hypomagnesemia in patients with PPI use was 1.43 (95% CI, 1.08-1.88). The association between the use of PPIs and hypomagnesemia remained significant after the sensitivity analysis including only studies with high quality score (Newcastle-Ottawa scale score 8) with a pooled RR of 1.63 (95% CI, 1.14-2.23). Conclusions: Our study demonstrates a statistically significant increased risk of hypomagnesemia in patients with PPI use. The finding of this meta-analysis of observational studies suggests that PPI use is associated with hypomagnesemia and may impact clinical management of patients who are taking PPIs and at risk for hypomagnesemia related cardiovascular events.

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Section: Discussionmentioning

confidence: 99%

Section: The Risk Of Hypomagnesemia In Patients With Ppi Usementioning

confidence: 99%

Proton pump inhibitors linked to hypomagnesemia: a systematic review and meta-analysis of observational studies

et al. 2015

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“…[2][3][4][5][6] Severe hypomagnesemia can present with tremor, changes in mental status, hallucinations, agitation, dizziness, tetany, seizures or cardiac arrhythmias.…”

Section: Discussionmentioning

confidence: 99%

Effect of Chronic Proton Pump Inhibitor Use on Serum Magnesium Levels in Pediatric Patients

Stanford¹,

Rahhal²

2015

Gastro Open J

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Hypomagnesemia has been reported in adult patients on Proton Pump Inhibitor (PPI) therapy. No studies have described the effect of this class on medications on Magnesium (Mg) levels in children. This was a retrospective cohort study assessing serum Mg levels in patients on PPI therapy followed by a pediatric gastroenterology service at a tertiary center. The study included 31 patients with a mean age of 7.8 years with 74 serum Mg levels. Duration of PPI therapy ranged between few days to more than 8 years. The main indication for PPI therapy was gastroesophageal reflux disease. Only 2 patients, of adult age, had Mg levels below the normal reference limit of 1.6 mg/dL. In one patient, multiple risk factors for hypomagnesemia were noted. For the entire cohort, there was no statistically significant difference in serum Mg levels over time or with chronic use (defined as more than 2 years). This study did not identify any patient less than 18 years of age with hypomagnesemia while on PPI therapy. Prospective larger long-term pediatric studies may still be needed to better assess the incidence of hypomagnesemia in children on PPI therapy.

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“…In the cross-sectional and case-controlled studies, in which the presence of hypomagnesaemia-related disease and the use of medication are taken as exclusion criteria, no relationship was found between magnesium deficiency and PPI (12,13). However, in two cross-sectional studies that were conducted recently, it was noted that the risk increased with the use of PPI in patients using diuretics (p<0.001), having GFR<60, and over 65 years of age (p=0.03) (14,15).…”

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confidence: 99%

What is the long term acid inhibitor treatment in gastroesophageal reflux disease? What are the potential problems related to long term acid inhibitor treatment in gastroesophageal reflux disease? How should these cases be followed?

Hatemı

Esatoğlu

2017

Turk J Gastroenterol

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Decreased acid secretion is thought to adversely affect the absorption of calcium and increase the risk of fracture by causing a decrease in bone density. The meta-analyses of observational studies conducted with heterogeneous populations showed that the risk of any fracture (OR: 1.29, 95% CI: 1.18-1.41) and hip fracture (OR: 1.23, 95% CI: 1.11-1.36) slightly increased with PPI depending on the dose and regardless of duration; but no risk increase was detected with H2RA use (1,2).There are meta-analyses with different methodologies reporting that high gastric pH values developing due to acid inhibition increases Clostridium difficile infections by altering the intestinal microflora and in observational studies conducted with different patient populations. This risk has been reported to be higher in PPI treatment (OR: 2.15, 95% CI: 1.81-2.55) compared to H2RA (OR: 1.44, 95% CI: 1.22-1.70) (3,4).It was reported in the meta-analysis published in 2013 that bacterial overgrowth increased with the use of PPI (OR: 2.26, 95% CI: 1.24-4.2) (5). Spontaneous bacterial peritonitis that develops due to the translocation of enteric pathogens is a significant cause of mortality for cirrhotic patients. The hypothesis that the risk of spontaneous bacterial peritonitis may increase due to easy proliferation of intestinal bacteria with decreased stomach acid has been confirmed in the meta-analysis of observational studies in which the relationship with PPI was investigated (OR: 3.15, 95% CI: 2.09-4.74). On the Turk J Gastroenterol 2017; 28(Suppl 1): S57-S60What is the long term acid inhibitor treatment in gastroesophageal reflux disease? What are the potential problems related to long term acid inhibitor treatment in gastroesophageal reflux disease? How should these cases be followed? S57 ABSTRACTThe meta-analyses of observational studies (OBS) showed the risk of any fracture and hip fracture slightly increased with proton pump inhibitor (PPI) treatment depending on the dose and regardless of time. This was not observed with histamine-2 receptor antagonists (H2RA). The risk of bacterial overgrowth and spontaneous bacterial peritonitis were increased with PPI therapy, but not with H2RA. In meta-analyses of OBS, a slight increase was observed in the risk of community-acquired pneumonia (CAP) in the early stages (<1 month) of PPI use and particularly at high doses. In a five-year LOTUS study, no difference was found in vitamin B12, folic acid, vitamin D, and calcium values in terms of the initial and end of follow-up levels. No increase in the risk of premalignant gastric lesions was observed in the meta-analysis of RCTs in which PPI treatment (≥6 months) was given to Helicobacter pylori negative patients. The risk of hypomagnesemia with PPI use was increased in patients having GFR<60, using diuretics, and over 65 years of age. Quasi-experimental studies showed a reduced zinc absorption with PPI use. In the meta-analysis of OBS, long-term (>1 year) PPI use increased the risk of fundic polyps, but no risk was found in shorter use. Th...

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Serum magnesium and proton-pump inhibitors use: a cross-sectional study

Abstract: The association of PPI use and hypomagnesemia is uncommon. Congenital defects in the metabolism of magnesium may be responsible for hypomagnesemia in some patients using this drug class.

Cited by 26 publications

References 14 publications

Proton pump inhibitors linked to hypomagnesemia: a systematic review and meta-analysis of observational studies

Proton pump inhibitors linked to hypomagnesemia: a systematic review and meta-analysis of observational studies

Effect of Chronic Proton Pump Inhibitor Use on Serum Magnesium Levels in Pediatric Patients

What is the long term acid inhibitor treatment in gastroesophageal reflux disease? What are the potential problems related to long term acid inhibitor treatment in gastroesophageal reflux disease? How should these cases be followed?

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