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
- 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