Association Between Proton Pump Inhibitor Use and Anemia: A Retrospective Cohort Study
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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.
KeywordsProton 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.
- 1.IMS Health Report. 2009 top therapeutic classes by US dispensed prescriptions. Available at: http://www.imshealth.com/deployedfiles/imshealth/Global/Content/StaticFile/Top_Line_Data/Top%20Therapy%20Classes%20by%20U.S.RXs.pdf. Accessed 9 June 2010.
- 2.IMS Health Report. 2009 top therapeutic classes by US sales. Available at: http://www.imshealth.com/deployedfiles/imshealth/Global/Content/StaticFile/Top_Line_Data/Top%20Therapy%20Classes%20by%20U.S.Sales.pdf. Accessed 9 June 2010.
- 8.FDA drug safety communication: Possible increased risk of fractures of the hip, wrist, and spine with the use of proton pump inhibitors, 2010. Available at: http://www.fda.gov/Drugs/DrugSafety/PostmarketDrugSafetyInformationforPatientsandProviders/ucm213206.htm. Accessed May 25, 2010.
- 9.Koop H. Review article: metabolic consequences of long-term inhibition of acid secretion by omeprazole. Aliment Pharmacol Ther. 1992;6:399–406.Google Scholar
- 14.Wheldon E, Venables C, Johnston I. Late metabolic sequelae of vagotomy and gastroenterostomy. Lancet. 1970;i:437–440.Google Scholar