Effect of long-term acid suppression therapy with proton pump inhibitors or H 2 receptor blockers on serum vitamin B 12
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BRIEF REPORT
Effect of long-term acid suppression therapy with proton pump inhibitors or H2 receptor blockers on serum vitamin B12 levels in elderly population Srinivasan Damodharan 1 & Gerard Marshall Raj 2 P Muraliswaran 4
&
M Sakthibalan 2 & Karthikeyan Dakshinamoorthy 3 &
Received: 1 September 2020 / Accepted: 15 October 2020 # Royal Academy of Medicine in Ireland 2020
Abstract Background Long-term usage of acid suppression drugs like proton pump inhibitors (PPIs) or H2 receptor blockers in the elderly population has been found to result in vitamin B12 deficiency. However, the reports are equivocal. Objective To determine the serum vitamin B12 levels in elderly patients under chronic acid suppression therapy. Methods Patients aged above 60 years and on any of the PPIs or H2 blockers for at least 6 months were recruited. Out of 77 patients recruited, 60 patients were included for the final analysis. The serum vitamin B12 levels were measured using the AccuDiag™-Vitamin B12 ELISA system. Results Out of 60 patients, pantoprazole (40%) and omeprazole (37%) were the commonly prescribed acid-suppressing drugs. Nearly 50% of the patients on prolonged acid suppression therapy were either “deficient” (less than 200 pg/ml) or “insufficient” (200 to 300 pg/ml) in serum vitamin B12 levels. Neither the average serum vitamin B12 levels (p = 0.994) nor the vitamin B12 status (p = 0.226) varied significantly across the drug groups of pantoprazole, omeprazole, and ranitidine. Conclusions Prolonged acid suppression therapy with PPIs or H2 blockers may result in serum vitamin B12 deficiency. However, there was no class (PPIs vs. H2 receptor blockers)- or drug (pantoprazole vs. omeprazole vs. ranitidine)-based differences found in the vitamin B12 deficiency caused. Keywords Histamine H2 antagonists . Omeprazole . Pantoprazole . Proton pump inhibitors . Vitamin B12 deficiency
Introduction Proton pump inhibitors (PPIs) and H2 blockers are prescribed commonly in primary care practice for the management of peptic ulcer disease and related disorders.
* Gerard Marshall Raj [email protected] Srinivasan Damodharan [email protected] M Sakthibalan [email protected] Karthikeyan Dakshinamoorthy [email protected] P Muraliswaran [email protected]
Prolonged usage of these drugs has been linked with the development of vitamin B12 deficiency, though not confirmed explicitly [1]. Vitamin B12 is released from food proteins with the aid of acid and pepsin; furthermore, the formation of pepsin
1
Sri Venkateshwaraa Medical College Hospital and Research Centre (SVMCH & RC), Pondy-Villupuram Main Road, Ariyur, Puducherry 605102, India
2
Department of Pharmacology, Sri Venkateshwaraa Medical College Hospital and Research Centre (SVMCH & RC), Pondy-Villupuram Main Road, Ariyur, Puducherry 605102, India
3
Department of General Medicine, Sri Venkateshwaraa Medical College Hospital and Research Centre (SVMCH & RC), Pondy-Villupuram Main Road, Ariyur, Puducherry 605102, India
4
Department of Biochemistry, Sri Venkateshwar
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