Vitamin B12 Deficiency Associated with Histamine2-Receptor Antagonists and a Proton-Pump Inhibitor

2002 ◽  
Vol 36 (5) ◽  
pp. 812-816 ◽  
Author(s):  
J Mark Ruscin ◽  
Robert Lee Page ◽  
Robert J Valuck
Keyword(s):  
Proton Pump Inhibitor ◽  
Gastroesophageal Reflux ◽  
Proton Pump ◽  
Serum Vitamin ◽  
Serum Folate ◽  
Dietary Vitamin ◽  
Vitamin B ◽  
Normal Range ◽  
Receptor Antagonists

OBJECTIVE: To report a case of vitamin B12 deficiency associated with long-term use (∼4½ y) of histamine2 (H2)-receptor antagonists and a proton-pump inhibitor (PPI) in a patient with gastroesophageal reflux. CASE SUMMARY: A 78-year-old nonvegetarian white woman with symptomatic gastroesophageal reflux (GER) was started on cimetidine 300 mg 4 × daily in February 1990 and took various other antisecretory medications over the course of the next 4½ years. She had a normal serum vitamin B12 concentration of 413 pg/mL in August 1992. In June 1994, her serum vitamin B12 concentration was found to be in the low normal range at 256 pg/mL. Biochemical markers of vitamin B12–dependent enzyme activity were measured at that time, and methylmalonic acid (MMA) and homocysteine (HCYS) were elevated at 757 nmol/L and 27.3 μmol/L, respectively. Serum folate was within the normal range at 4.9 ng/mL, and serum creatinine was slightly elevated at 1.4 mg/dL. MMA and HCYS concentrations decreased dramatically with oral replacement of vitamin B12 1000 μg/d, which confirmed vitamin B12 deficiency. Oral replacement also demonstrated that the woman was able to adequately absorb nonprotein—bound vitamin B12 from the gastrointestinal tract, suggesting that her deficiency was a result of food—cobalamin malabsorption. The accumulation of MMA and HCYS was not a consequence of renal dysfunction, since both metabolites dramatically decreased with vitamin B12 replacement. DISCUSSION: Malabsorption of dietary protein-bound vitamin B12 has been demonstrated with the use of H2-receptor antagonists and PPIs. One previous case report of vitamin B12 deficiency resulting from long-term use of omeprazole has been published. The malabsorption of dietary vitamin B12 is thought to be a result of its impaired release from food protein, which requires gastric acid and pepsin as the initial step in the absorption process. CONCLUSIONS: The use of H2-receptor antagonists and/or PPIs may impair the absorption of protein-bound dietary vitamin B12 and could contribute to the development of vitamin B12 deficiency with prolonged use. Patients taking these medications for extended periods of time, particularly >4 years, should be monitored for vitamin B12 status.

scholarly journals Haematological studies on vegans

1978 ◽  
Vol 40 (1) ◽  
pp. 9-15 ◽  
Author(s):  
T. A. B. Sanders ◽  
F. R. Ellis ◽  
J. W. T. Dickerson
Keyword(s):  
Haemoglobin Concentration ◽  
Serum Vitamin ◽  
Mean Value ◽  
Serum Folate ◽  
Vitamin B ◽  
Normal Range ◽  
Blood Formation ◽  
Mean Corpuscular Haemoglobin ◽  
Erythrocyte Folate ◽  
The Mean

1. The concentrations of vitamin B12 and folate in the serum and folate in the erythrocytes were determined and full blood counts made on a series of caucasian vegans and omnivore controls.2. The blood counts and films were normal in all the vegans and no subject had a haemoglobin concentration below the lower limit of normality.3. Although within the normal range, male but not female vegans had lower values for erythrocyte counts and higher values for mean corpuscular volume and mean corpuscular haemoglobin than their controls regardless of whether they were taking vitamin B12 supplements or not.4. The mean serum vitamin B12 concentration was lower in the vegans not taking vitamin B12 supplements and in those using foods supplemented with the vitamin than in the controls, but in no subject was it below 80 ng/l.5. The serum folate concentrations were higher in the vegans than in their controls. The mean value for erythrocyte folate tended to be greater in the vegans not taking vitamin B12 supplements. No subject had an erythrocyte folate concentration of less than 100μg/l.6. It is concluded that megaloblastic anaemia is very rare in caucasian vegans and that a diet consisting entirely of plant foods is generally adequate to promote normal blood formation providing it is composed of a mixture of unrefined cereals, pulses, nuts, fruit and vegetables and is supplemented with vitamin B12.

Toxicity of long-term use of proton pump inhibitors in children

2017 ◽  
Vol 103 (1) ◽  
pp. 78-82 ◽  
Author(s):  
Pauline De Bruyne ◽  
Shinya Ito
Keyword(s):  
Proton Pump Inhibitor ◽  
Tract Infection ◽  
Respiratory Tract ◽  
Respiratory Tract Infection ◽  
Proton Pump Inhibitors ◽  
Proton Pump ◽  
Bone Fractures ◽  
Vitamin B ◽  
In Infants And Children

Proton pump inhibitor (PPI) use is becoming increasingly common. Although the toxicity profiles of PPIs are not well understood particularly in children, PPIs have been associated with increased risks of gastrointestinal and respiratory tract infection, vitamin B12 deficiency, hypomagnesaemia, bone fractures, and rebound hyperacidity after discontinuation. Prescribers should take into account that PPI uses pose toxicity risks, which remain to be fully characterised in infants and children.

scholarly journals Long‑term vonoprazan therapy is effective for controlling symptomatic proton pump inhibitor‑resistant gastroesophageal reflux disease

2021 ◽  
Vol 14 (3) ◽  
Author(s):  
Satoshi Shinozaki ◽  
Hiroyuki Osawa ◽  
Yoshikazu Hayashi ◽  
Yoshimasa Miura ◽  
Alan Lefor ◽  
...  
Keyword(s):  
Gastroesophageal Reflux Disease ◽  
Proton Pump Inhibitor ◽  
Gastroesophageal Reflux ◽  
Proton Pump ◽  
Reflux Disease

Potential reasons for proton pump inhibitor failure in the treatment of gastroesophageal reflux disease

2008 ◽  
Vol 149 (40) ◽  
pp. 1881-1888 ◽  
Author(s):  
Márk Juhász ◽  
Zsolt Tulassay
Keyword(s):  
Gastroesophageal Reflux Disease ◽  
Proton Pump Inhibitor ◽  
Gastroesophageal Reflux ◽  
Proton Pump ◽  
Reflux Disease

A protonpumpagátlók (protonpumpa-inhibitorok, PPI) bevezetése új fejezetet nyitott a gastrooesophagealis refluxbetegség (gastroesophageal reflux disease, GERD) kezelésében. A betegek kisebb, de nem jelentéktelen hányadában azonban a PPI sem hatékony. Ilyen esetekben az első kérdés mindig az, hogy a tünetek valóban GERD-nek tulajdoníthatók-e, vagy egyéb betegség után kell kutatnunk. Ha a GERD a legvalószínűbb lehetőség, akkor a további vizsgálatok és a több támadáspontú kezelés előtt fel kell térképeznünk a beteg együttműködését (compliance). Ha az eredménytelen PPI-kezelés hátterében nem helytelenül kezelt GERD áll, akkor számos egyéb kórkép lehetőségét is fel kell vetnünk. Összefoglaló közleményünkben az elkülönítő diagnosztikai kérdésekről adunk áttekintést.

scholarly journals Masked vitamin B12 and folate deficiency in the elderly

1985 ◽  
Vol 54 (3) ◽  
pp. 613-619 ◽  
Author(s):  
G. M. Craig ◽  
C. Elliot ◽  
K. R. Hughes
Keyword(s):  
Clinical Investigation ◽  
Binding Capacity ◽  
Serum Vitamin ◽  
The Elderly ◽  
Folate Deficiency ◽  
Significant Negative Correlation ◽  
Serum Folate ◽  
Fe Deficiency ◽  
Vitamin B ◽  
Geriatric Unit

1. A high incidence of vitamin B12 or folate deficiency, or both, may be found in the elderly, particularly those in hospital. This report concerns fifty cases detected in an inner-city-area geriatric unit during the course of routine clinical investigation. The majority had none of the classical haematological signs of vitamin B12 or folate deficiency, and all the patients reported had a mean corpuscular volume (MCV) of less than 100 fl.2. There was a significant negative correlation between the MCV and the erythrocyte folate (P< 0.01), supporting earlier published work using a low serum folate as an index of folate deficiency.3. There was no correlation between the MCV and the serum vitamin B12. Published work differs on this point.4. Serum iron, total Fe-binding capacity and percentage Fe saturation results were available in forty patients in this series. There was a significant positive correlation between the serum Fe and the MCV (P<0.01) and 34% of patients had haematological evidence of Fe deficiency. In the majority, however, there was no evidence that associated Fe deficiency had masked the haematological signs of vitamin B12 or folate deficiency.5. More attention should be paid to the problem of ‘masked’ vitamin B12 and folate deficiency in the elderly. There is a case for routine screening of the elderly for vitamin B12 and folate deficiency irrespective of the MCV.

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