AGS: Long-Term Proton Pump Inhibitor Use Does Not Reduce Vitamin B12 Absorption

By Peggy Peck
3 may 2008-- Long-term use of proton pump inhibitors did not adversely impact vitamin B12 status, researchers here reported.
In a study of 125 couples in which one partner used the drugs and the other did not, there was no significant difference in the prevalence of low vitamin B12 levels, said Wendy P.J. den Elzen, M.Sc., of Leiden University Medical Center in the Netherlands.
Den Elzen said several short-term studies have suggested that proton pump inhibitors use was associated with decreased absorption of vitamin B12, which has prompted some geriatricians to recommend periodic screening of elderly users for vitamin deficiency.
"But in this study, the average vitamin B12 level was 345 pmol/L among the drug users and 339 pmol/L among non-users," she said.
They defined low vitamin B12 levels as less than 150 pmol/L, which was observed in 3% of users versus 2% of non-users,

The participants were recruited from 39 general practices in the Leiden Primary Care Research Network; 206 couples were invited to participate and 125 completed study questionnaires and agreed to blood tests.
Partners who shared the same dwelling for three or more years served as controls. Long-term use was defined as at least 840 doses in three years.
The median age of drug users and non-users was 73, and 55% of users were women. Among PPI users, 21% also took over-the-counter multivitamins, compared with 19% of non-users.
The median duration of proton pump inhibitors use was six years. Most users (66%) said they took the drug to treat gastroesophageal reflux disease, 5% said they used it for peptic ulcers, 5% to treat GI side-effects of NSAIDs, and 25% said they took PPIs for other reasons.
Persons who used parenteral vitamin B12 supplements, folic acid supplements, H2-blockers, and antacids for the three years preceding study entry were excluded.
Among study participants, 32% of the proton pump inhibitors users and 41% of non-users tested positive for Helicobacter pylori.
When the data were analyzed by duration of use, "we found no increased risk of vitamin B12 deficiency with increased duration," den Elzen said.
There were also no differences in homocysteine levels or in mean corpuscular volume (MCV).
Asked about fracture risk or increased risk of peritonitis or Clostridium difficile-associated disease -- both of which have been reported in other studies -- among the PPI users, den Elzen said she and her colleagues did not collect data on either condition .The study was funded by the Leiden University Medical Center, Public Health and Primary Care Division.
Ms. den Elzen said she had no financial disclosures.

Primary source: American Geriatrics Society MeetingSource reference:den Elzen W, et al "Long-term use of proton pump inhibitors and vitamin B12 status in elderly individuals" C53