December 11th, 2013
11:00 AM ET
Patients who use certain acid-suppressing drugs for heartburn over a period of two years or longer are more likely to suffer from a vitamin B12 deficiency than those who do not use them, according to a new study released Tuesday.
The drugs, known as proton-pump inhibitors (PPI) and histamine 2 receptor antagonists (H2 blockers), are available by prescription and over-the-counter, under names such as Prilosec and Nexium. They are designed to treat gastroesophageal reflux disease, or GERD, as well as other acid-related conditions.
Researchers at Kaiser Permanente in Oakland, California, looked at the medical records of 25,956 adults who received vitamin B12 deficiency diagnoses between 1997 and 2011, comparing them with 184,199 patients without B12 deficiencies.
They found patients who took PPIs for more than two years were 65% more likely to have a vitamin B12 deficiency and when patients were given higher doses of the PPIs, the deficiency was even more prevalent. The risk of deficiency was not has high in patients who used H2 blockers long-term: 4.2%, compared with 3.2% of nonusers.
But with both drug types, researchers say they believe this happens because these medications suppress the production of gastric acid, which keeps the body from absorbing vitamin B12.
Although B12 deficiency is not uncommon, especially in older adults, a serious drop in the vitamin can lead to problems such as anemia, dementia and neurologic damage.
“There are a few take-home messages from the study results,” said Dr. Douglas A. Corley, senior author of the study, published in the Journal of the American Medical Association. “First, patients who have been on these medications for two years or more should be screened for B12 deficiency. And second, these patients need to be aware of certain conditions that may be caused by the lack of B12. Many times symptoms of B12 deficiency just sneak up on people, and they need to know why this may be happening.”
Dr. Gagan Beri, a board certified gastroenterologist with Coastal Healthcare in Ocean Township, New Jersey, says although it’s a very interesting study, doctors have to look at the patient as a whole.
“We don’t routinely check for vitamin B deficiency and at this point it really depends on the patient," said Beri. " A lot of my patients have serious problems like ulcers and acid reflux, and these medications work for them. There needs to be a balance of what’s the best treatment for the patient.”
“I think the study needs to be better quantified, “Beri continued. “Who is more at risk and do they have other problems that could contribute to the B12 deficiency? In this study women seemed more at risk for the deficiency, although in our practice men are more prone to have acid reflux problems. And there may be missed conditions, like Celiac and Crohn’s disease. Both of these conditions can lead to B12 deficiency. So you have to look at the entire health profile.”
This is the largest study to determine a link between taking acid-suppressing medications and vitamin B12 deficiency in all age groups. According to the American College of Gastroenterology, 60 million Americans suffer from some form of heartburn or acid reflux at least once a month. And according to the report, nearly 157 prescriptions for PPIs have been written this year to help patients deal with chronic acid reflux problems.
“These results do not mean that if you’re on these acid suppressing medications, that you should give them up,” warned Corley.” Patients need to talk to their doctors and perhaps make sure that the dose they are getting is appropriate for the problem they are facing when it comes to their acid reflux, and that perhaps a lower dose would be just as effective and not as harmful.”
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