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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. …

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