Vitamin B12 deficiency in hypersecretors during long‐term acid suppression with proton pump inhibitors

Hirschowitz, Basil I.; Worthington, Julie; Mohnen, Jean

doi:10.1111/j.1365-2036.2008.03658.x

Cited by 100 publications

(71 citation statements)

References 41 publications

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“…Because measuring B 12 levels alone may fail to detect subclinical deficiency, Hirschowitz et al also measured methylmalonic acid (MMA) and homocysteine levels in patients receiving long-term PPI therapy. When measuring only serum B 12 levels, 10% of patients exhibited subnormal levels but, by monitoring all three parameters, subclinical B 12 deficiency was detected in 31% of patients with normal B 12 levels [19]. Rozgony et al conducted the most recent study, which involved 36 long-term care residents aged 60-89 years [20].…”

Section: Introductionmentioning

confidence: 98%

Adverse Effects of Long-Term Proton Pump Inhibitor Therapy

2011

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Proton pump inhibitors have an excellent safety profile and have become one of the most commonly prescribed class of drugs in primary and specialty care. Long-term, sometimes lifetime, use is becoming increasingly common, often without appropriate indications. This paper is a detailed review of the current evidence on this important topic, focusing on the potential adverse effects of long-term proton pump inhibitor use that have generated the greatest concern: B12 deficiency; iron deficiency; hypomagnesemia; increased susceptibility to pneumonia, enteric infections, and fractures; hypergastrinemia and cancer; drug interactions; and birth defects. We explain the pathophysiological mechanisms that may underlie each of these relationships, review the existing evidence, and discuss implications for clinical management. The benefits of proton pump inhibitor use outweigh its risks in most patients. Elderly, malnourished, immune-compromised, chronically ill, and osteoporotic patients theoretically could be at increased risk from long-term therapy.

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Section: Introductionmentioning

confidence: 98%

Adverse Effects of Long-Term Proton Pump Inhibitor Therapy

2011

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“…PPI and H2B have been shown to suppress acid secretion by parietal cells and impair the absorption of protein bound dietary vitamin B12 and thus contribute to the development of vitamin B12 deficiency (Howden, 2000;Ruscin et al, 2002;Force et al, 2003;den Elzen et al, 2008;Ali et al, 2009). The current evidence of vitamin B12 deficiency associated with longterm PPI use however is based on small nonrandomized retrospective studies (Steinberg et al, 1980;Marcuard et al, 1994;Termanini et al,1998;Hirschowitz et al, 2008). Overall the current collective body of information supports the notion that prolonged use of PPI notably in the elderly and in persons on high doses of PPI is associated with increased risk of vitamin B12 deficiency (Thomas et al, 2010).…”

Section: Implications Of Metformin Use In Type 2 Diabetic Patients 4mentioning

confidence: 68%

Characteristics of Vitamin B12 Deficiency in Adult Chinese Patients with Type 2 Diabetes and the Implication of Metformin

Joyce¹,

Florence²,

Howard³

et al. 2011

Topics in the Prevention, Treatment and Complications of Type 2 Diabetes

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“…1,7,12 Relapse was defined endoscopically as esophagitis grade 2 or greater and peptic ulcer 3 mm or greater, and symptomatically as moderate to severe symptoms calling for an increase or division of the dose which included dyspepsia, abdominal pain, and heartburn, particularly at night. ZE and pseudo-ZE were defined using previously proposed criteria.…”

Section: Methodsmentioning

confidence: 99%