Den Elzen WPJ, Groeneveld Y, De Ruijter W, et al. Long-term use of proton pump inhibitors and vitamin B₁₂ status in elderly individuals. Aliment Pharmacol Ther 2008;27:491–7.

At a time when the long-term use of proton pump inhibitors (PPIs) is becoming increasingly maligned as a result of large database studies suggesting an increased risk of osteoporotic hip fracture, community acquired pneumonia and infectious diarrhoea, it is refreshing to find a well-designed study from Holland examining the implications of their long-term use on vitamin B₁₂ levels in the elderly.

Previous investigators have suggested that long-term acid suppression decreases absorption of B₁₂ and will ultimately result in B₁₂ deficiency. This cross-sectional survey suggests that while the former may be physiologically correct, the latter does not occur. Den Elzen and colleagues measured serum B₁₂ levels, homocysteine and mean cell volume in 125 long-term (median duration of treatment 6 years) PPI users aged ⩾65 years. In order to minimise differences in dietary intake of B₁₂ as a potential confounder, they used the patients’ partners as controls and also estimated dietary B₁₂ intake using a questionnaire. …