Introduction Proton pump inhibitors (PPIs) have long been established as an effective evidence based therapy for many upper gastrointestinal diseases including peptic ulcer disease, gastro-oesophageal reflux disease, oesophagitis and dyspepsia. However, nonjudicious use of PPIs creates both preventable financial as well as medical concerns. There are several studies that point to potential micronutrient deficiencies including iron, vitamin B12, magnesium and calcium as a consequence of long-term PPI use. While these risks are considered to be relatively low in the general population, they may be notable in elderly and malnourished patients on PPIs. Although high quality evidence for the true burden of deficiency is scarce, clinicians should have an awareness of the potential for these side effects in patients, particularly those on long-term PPIs. We hypothesised that despite increasing evidence of micronutrient deficiency in patients on long term PPIs, this is not assessed in clinical practice.
Methods A single centre, retrospective analysis of all patients on long term PPIs usage in a large NHS North London trust was performed. Patients with Barrett’s oesophagus were used as a database of patients on long term PPIs. Their names were identified from the Unisoft endoscopy reporting system as undergoing endoscopic surveillance for Barrett’s. We reviewed their electronic patient records to see if they had ever had their indices for B12, ferritin or magnesium tested whilst they had been undergoing outpatient clinical review.
Results Of 41 patients identified, 38 (92.7%) had not had serum magnesium checked in the last 12 months including 15 (36.59%) who had never had it checked. 32 (78.1%) had not had serum ferritin or B12 checked in the past 12 months. Including 9 (21.95%) whom had never had it checked. The median magnesium level was low (0.77, range 0.76–0.89). The median ferritin was normal (106, range 13–196). There was one incidence of B12 deficiency (2.44% all patients, 31.3% of all those tested). Median serum B12 was normal (351, range 10.6–645).
Conclusion Despite evidence in the literature of an association between long term PPI use and micronutrient deficiency, the investigation for this by clinicians in a high-risk group was poor and inconsistent. Even in this small cohort, magnesium and B12 deficiency was detected. We would recommend that clear guidance from the British Society of Gastroenterology and other national Gastroenterology bodies on micronutrient monitoring in patients on long term PPIs is required. This may improve screening of micronutrients in long term PPI usage and identify those requiring supplementation.
Disclosure of Interest None Declared
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