Increase awareness of PPI harms: researchers

rendering of iron capsule

New research has found a link between use of proton pump inhibitors and iron deficiency

A collaboration between academics at the Universities of Melbourne, Utrecht and Maastricht is the first population-based study to find that PPIs are associated with iron deficiency.

Iron deficiency is the most common cause of anaemia, and affects about 2.2 billion people globally.

Dr An Duy Tran, a Senior Research Fellow at the Melbourne School of Population and Global Health, says PPIs could lead to iron malabsorption because acid is needed for iron absorption.

“Whether or not PPI use led to iron deficiency has long been inconclusive,” he said.

The study, published in published in Journal of Internal Medicine, showed that continuous PPI use for more than one year increased the risk of iron deficiency.

People using one tablet of 20 mg PPI or more daily had a higher risk of iron deficiency compared with people using less than one tablet daily.

The cases were patients aged 19 or older with a first time diagnosis of iron deficiency between 2005 and 2016 (n=26,806).

They were classified as a “full” PPI user or PFU (having received PPIs for a continuous duration of at least one year before the index date); a limited user or PLU if they intermittently received PPI therapy; or non-users, PNUs, who had received no PPI therapy before the index date.

“Among cases, 2960 were PFU, 6607 PLU and 17 239 PNU. Among controls, 1091 were PFU, 5058 PLU and 20 657 PNU,” the authors wrote.

“Adjusted odds ratio of ID in PFU and PLU compared to PNU was 3.60 (95%CI, [3.32–3.91]) and 1.51 (95% CI, [1.44–1.58]). Positive dose–response and time–response relationships were observed.”

“Many doctors tend to overprescribe proton pump inhibitors and do not rigorously weigh their benefits against their harms,” Dr Tran said.

“It is important to increase awareness about the harmful effects.

“To my knowledge current guidelines do not recommend regular iron monitoring during PPI administration. It seems that many doctors are not aware of the time and dose-response in patients using PPIs.”

Other recent studies have shown that long-term use of PPIs is associated with gastric cancer and enteric infection, chronic kidney disease and pneumonia.

More than 19 million prescriptions for proton pump inhibitors were written in Australia during 2013-2014.

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