Digestive Diseases and Sciences

, Volume 56, Issue 8, pp 2349–2353 | Cite as

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

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



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 inhibitor Anemia Malabsorption Iron deficiency 



We are grateful to Adriano Tonelli, MD for providing the inspiration for this research. We also thank Abhimanyu Beri, MD and Sahibzada Usman Latif, MD for their critical review of the manuscript.

Conflict of interest

None reported for any authors.


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Copyright information

© Springer Science+Business Media, LLC 2011

Authors and Affiliations

  • Erin Sarzynski
    • 1
    Email author
  • 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

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