Heartburn, Ulcer Medications May Contribute To Vitamin B12 Deficiency
December 11, 2013

Long-Term Use Of Acid Reducers Linked To Vitamin B12 Deficiency

redOrbit Staff & Wire Reports - Your Universe Online

Using commonly prescribed heartburn and/or ulcer medications regularly over a long period of time has been linked to an increased risk of vitamin B12 deficiency, experts from the Kaiser Permanente Division of Research report in a new study.

Writing in the December 11 edition of the Journal of the American Medical Association, the researchers explain that stomach acid aids in absorption of the vitamin, and that prolonged suppression of those acids can result in low B12 levels. Left untreated, vitamin B12 deficiency can increase a person’s risk of dementia, nerve damage, anemia and other medical conditions.

Jameson R. Lam and his colleagues looked at the electronic health records of more than 25,000 adult Kaiser Permanente patients from Northern California who were diagnosed as being B12 deficient between January 1997 and June 2011. They compared those records, which included laboratory results and diagnoses, to those of over 184,000 patients without the same vitamin deficiency during the same period.

The study authors claim that this is the first large-scale, population-based study to associate vitamin B12 deficiency to commonly-prescribed acid-suppressing drugs. Last year, approximately 15 million people received well over 150 million prescriptions for one class of acid reducers known as protein pump inhibitors (PPIs).

“Patients who took PPI medications for more than two years had a 65 percent increase in their risk of B12 deficiency,” Dr. Douglas A. Corley, a gastroenterologist and research scientist with the Kaiser Permanente Division of Research, explained in a statement Tuesday. “Higher doses also were associated with an increased risk, compared with lower doses. Kaiser Permanente's electronic health records allowed us to look at what happens in the real world for these commonly used medications.”

The study discovered that receiving two or more years’ worth of PPIs or histamine 2 receptor antagonists (H2RAs) was associated with an increased risk of B12 deficiency, and that doses of more than 1.5 PPI pills per day were more strongly linked with low levels of the vitamin than doses of less than 0.75 pills per day.

The investigators also found that the link was stronger in women and younger adults with more potent acid suppression, and that the association decreased after the patient discontinued using the drugs. No significant trend with increasing duration of use was discovered, according to the study authors.

“We cannot completely exclude residual confounding [factors besides the drugs] as an explanation for these findings, but, at minimum, the use of these medications identifies a population at higher risk of B12 deficiency, independent of additional risk factors,” they wrote.

“These findings do not recommend against acid suppression for persons with clear indications for treatment, but clinicians should exercise appropriate vigilance when prescribing these medications and use the lowest possible effective dose,” the authors added. “These findings should inform discussions contrasting the known benefits with the possible risks of using these medications.”