Digestive Diseases and Sciences

, Volume 56, Issue 8, pp 2349–2353

Association Between Proton Pump Inhibitor Use and Anemia: A Retrospective Cohort Study

  • Erin Sarzynski
  • Chethan Puttarajappa
  • Yan Xie
  • Madhusudan Grover
  • Heather Laird-Fick
Original Article

DOI: 10.1007/s10620-011-1589-y

Cite this article as:
Sarzynski, E., Puttarajappa, C., Xie, Y. et al. Dig Dis Sci (2011) 56: 2349. doi:10.1007/s10620-011-1589-y



Proton pump inhibitors (PPIs) are widely prescribed to treat gastrointestinal diseases. However, concerns have been raised regarding their long-term use. Gastric acid suppression may decrease iron absorption, and it remains uncertain whether iron-deficiency anemia may result from chronic PPI therapy.


We aimed to explore the association between chronic PPI use and iron-deficiency anemia.


We conducted a retrospective cohort study of adult patients in an academic outpatient setting who received PPI therapy for at least 1 year between January 1, 2004 and January 1, 2006. We compared the change in hematologic indices among patients receiving PPI therapy for at least 1 year with matched controls.


Of the 98 patients on chronic PPI therapy who met inclusion criteria, 35% had no documented indication for such therapy. At baseline, demographics and hematologic indices were similar between PPI-users and controls. Among patients on PPI therapy, all hematologic indices decreased from baseline, including hemoglobin (−0.19 g/dL, P = 0.03), hematocrit (−0.63%, P = 0.02), and mean corpuscular volume (−0.49 fL, P = 0.05). PPI users had significant decreases in mean hemoglobin and hematocrit (P < 0.01 for both) compared with matched controls. After adjustment for confounders, including rates of esophagogastroduodenoscopy, colonoscopy and remote cancer status, the odds ratio of decreasing hemoglobin by 1.0 g/dL while on chronic PPI therapy was 5.03 (95% CI, 1.71–14.78, P < 0.01), while the odds ratio of decreasing hematocrit by 3% was 5.46 (95% CI, 1.67–17.85, P < 0.01).


Among adult patients receiving chronic PPI therapy, there is a significant decrease in hematologic indices from baseline.


Proton pump inhibitorAnemiaMalabsorptionIron deficiency

Copyright information

© Springer Science+Business Media, LLC 2011

Authors and Affiliations

  • Erin Sarzynski
    • 1
  • Chethan Puttarajappa
    • 2
  • Yan Xie
    • 3
  • Madhusudan Grover
    • 4
  • Heather Laird-Fick
    • 1
  1. 1.Department of MedicineMichigan State UniversityEast LansingUSA
  2. 2.Department of Medicine, Renal-Electrolyte DivisionUniversity of PittsburghPittsburghUSA
  3. 3.Center for Statistical Training and ConsultingMichigan State UniversityEast LansingUSA
  4. 4.Division of Gastroenterology and HepatologyMayo ClinicRochesterUSA