PMID- 27890768
OWN - NLM
STAT- MEDLINE
DCOM- 20170621
LR  - 20180405
IS  - 1528-0012 (Electronic)
IS  - 0016-5085 (Linking)
VI  - 152
IP  - 4
DP  - 2017 Mar
TI  - Proton Pump Inhibitor and Histamine-2 Receptor Antagonist Use and Iron
      Deficiency.
PG  - 821-829.e1
LID - S0016-5085(16)35392-6 [pii]
LID - 10.1053/j.gastro.2016.11.023 [doi]
AB  - BACKGROUND & AIMS: Proton pump inhibitors (PPIs) and histamine-2 receptor
      antagonists (H2RAs) suppress gastric acid production, which can inhibit iron
      absorption. However, few data exist regarding whether these medications increase 
      the risk of clinical iron deficiency. METHODS: A community-based case-control
      study evaluated the association between acid-suppressing medication use and the
      subsequent risk of iron deficiency. It contrasted 77,046 patients with new iron
      deficiency diagnoses (January 1999-December 2013), with 389,314 controls.
      Medication exposures, outcomes, and potential confounders used electronic
      databases. We excluded patients with pre-existing risk factors for iron
      deficiency. Associations were estimated using conditional logistic regression.
      RESULTS: Among cases, 2343 (3.0%) received a prior >/=2-year supply of PPIs and
      1063 (1.4%) received H2RAs (without PPI use). Among controls, 3354 (0.9%)
      received a prior >/=2-year supply of PPIs and 2247 (0.6%) H2RAs. Both >/=2 years 
      of PPIs (adjusted odds ratio, 2.49; 95% confidence interval, 2.35-2.64) and >/=2 
      years of H2RAs (odds ratio, 1.58; 95% CI, 1.46-1.71) were associated with an
      increased subsequent risk for iron deficiency. Among PPI users, the associations 
      were stronger for higher daily doses (>1.5 vs <0.75 PPI pills/d; P value
      interaction = .004) and decreased after medication discontinuation (P-trend <
      .001). Some of the strongest associations were among persons taking >1.5 pills
      per day for at least 10 years (odds ratio, 4.27; 95% CI, 2.53-7.21). No similar
      strong associations were found for other commonly used prescription medications. 
      CONCLUSIONS: Among patients without known risk factors for iron deficiency,
      gastric acid inhibitor use for >/=2 years was associated with an increased
      subsequent risk of iron deficiency. The risk increased with increasing potency of
      acid inhibition and decreased after medication discontinuation.
CI  - Copyright (c) 2017 AGA Institute. Published by Elsevier Inc. All rights reserved.
FAU - Lam, Jameson R
AU  - Lam JR
AD  - Kaiser Permanente Division of Research, Oakland, California.
FAU - Schneider, Jennifer L
AU  - Schneider JL
AD  - Kaiser Permanente Division of Research, Oakland, California.
FAU - Quesenberry, Charles P
AU  - Quesenberry CP
AD  - Kaiser Permanente Division of Research, Oakland, California.
FAU - Corley, Douglas A
AU  - Corley DA
AD  - Kaiser Permanente Division of Research, Oakland, California. Electronic address: 
      Douglas.Corley@kp.org.
LA  - eng
PT  - Journal Article
PT  - Research Support, Non-U.S. Gov't
DEP - 20161124
PL  - United States
TA  - Gastroenterology
JT  - Gastroenterology
JID - 0374630
RN  - 0 (Histamine H2 Antagonists)
RN  - 0 (Proton Pump Inhibitors)
RN  - E1UOL152H7 (Iron)
SB  - AIM
SB  - IM
MH  - Adult
MH  - Aged
MH  - Aged, 80 and over
MH  - Case-Control Studies
MH  - Female
MH  - Histamine H2 Antagonists/administration & dosage/*adverse effects
MH  - Humans
MH  - Iron/*deficiency
MH  - Malabsorption Syndromes/chemically induced
MH  - Male
MH  - Middle Aged
MH  - Proton Pump Inhibitors/administration & dosage/*adverse effects
MH  - Time Factors
OTO - NOTNLM
OT  - *Acid Suppressing
OT  - *Epidemiology
OT  - *Iron Deficiency
OT  - *Medications
EDAT- 2016/11/29 06:00
MHDA- 2017/06/22 06:00
CRDT- 2016/11/29 06:00
PHST- 2015/09/02 00:00 [received]
PHST- 2016/10/28 00:00 [revised]
PHST- 2016/11/16 00:00 [accepted]
PHST- 2016/11/29 06:00 [pubmed]
PHST- 2017/06/22 06:00 [medline]
PHST- 2016/11/29 06:00 [entrez]
AID - S0016-5085(16)35392-6 [pii]
AID - 10.1053/j.gastro.2016.11.023 [doi]
PST - ppublish
SO  - Gastroenterology. 2017 Mar;152(4):821-829.e1. doi: 10.1053/j.gastro.2016.11.023. 
      Epub 2016 Nov 24.