Heartburn and ulcer treatments connected to Vitamin B12 deficiency

by Bruce Sylvester – Long-term treatment with some prescription heartburn and ulcer medications appears to be related to an increased risk of vitamin B12 deficiency, researchers reported on Dec. 10, 2013 in the Journal of the American Medical Association.

As background, the authors noted that stomach acid assists vitamin B12 absorption, and acid  suppression can cause vitamin b12 deficiency. Untreated vitamin B12 deficiency can lead to an increased risk of dementia, nerve damage, anemia, and other medical complications.

The investigators retrospectively analyzed electronic health records of 25,956 adult patients on the Kaiser Permanente plan  in Northern California who had been diagnosed with vitamin B12 deficiency between January 1997 and June 2011. They compared the data to that of 184,199 patients without B12 deficiency, seen by physicians on the Kaiser Permanete health plan during the same time period.

“Patients who took PPI  [proton pump inhibitor] medications for more than two years had a 65 percent increase in their risk of B12 deficiency,” said lead investigator Douglas Corley, M.D., Ph.D, gastroenterologist and research scientist with the Kaiser Permanente Division of Research in Oakland, California. “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.”

Among the 25,956 subjects with vitamin B12 deficiency, 12 percent used PPIs for at least two years, compared with 7.2 percent of the control subjects.

The effect of daily dosing with H2RA medications (histamine h2-antagonists ) was less pronounced but still significant, with 4.2 percent of the treated  patients developing B12 deficiency compared with  3.2 percent of control patients.

“This research raises the question of whether people who are taking acid-depressing medications long term should be screened for vitamin B12 deficiency,” Dr. Corley added. “It’s a relatively simple blood test, and vitamin supplements are an effective way of managing the vitamin deficiency, if it is found.”