Proton pump inhibitors suppress absorption of dietary non-haem iron in hereditary haemochromatosis

Carol Hutchinson ¹, Catherine Geissler ¹, Jonathan Powell ² and Adrian Bomford ^1*

¹ King's College London, United Kingdom
² MRC Human Nutrition Research, United Kingdom

^* To whom correspondence should be addressed. E-mail: adrian.bomford{at}kcl.ac.uk.

Accepted 28 February 2007

Abstract

Background and Aims: During the long-term treatment of patients with hereditary haemochromatosis (HH) we observed that proton pump inhibitors (PPI) reduced the requirement for maintenance phlebotomy. Gastric acid plays a crucial role in non-haem iron absorption and we performed a case review and intervention study to investigate if PPI-induced suppression of gastric acid would reduce dietary iron absorption in C282Y homozygous patients.

Methods: Phlebotomy requirements to keep serum ferritin ~ 50ug/l before (6.1 ± 0.6 years, mean ± S.E) and during (3.8 ± 0.9 years) administration of a PPI were evaluated in seven patients and a post-prandial study was performed to determine whether PPIs reduce absorption of non-haem iron (14.5 mg) from a test meal in a further 14 phlebotomised patients with normal iron stores.

Results: There was a significant reduction (p < 0.001) in the volume of blood removed annually before (2.5 ± 0·25 l) and while taking (0.5 ± 0.25 l) a PPI. Administration of a PPI for 7d suppressed absorption of non-haem iron from the meal as shown by a significant reduction (all p <0·01) in: area under the serum curve (2145 ± 374 versus 1059 ± 219), % recovery of administered iron at peak serum iron (20·5 ± 3·2 versus 11·0 ± 2·0 %) and peak serum iron (13.6 ± 2·4 versus 6.1 ± 1·2 µmol/l) - all values: before versus during PPI.

Conclusions: Administration of a PPI to patients with HH can inhibit the absorption of non-haem iron from a test meal and the habitual diet.

Keywords: gastric acid, hereditary haemochromatosis, iron absorption, iron stores, proton pump inhibitor

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