vitamin-b-12 and Gastroesophageal-Reflux

As acid suppression therapies with proton pump inhibitors are an extremely common practice for common acid-related diseases, there has been increased scrutiny on the safety of this class of therapy.. There have been increasing reports of allegation of harm with the sustained use of proton pump inhibitors, in particular with potential adverse effects on vitamin and mineral absorption. This has prompted a number of product label changes directed by the US Food and Drug Administration, raising concerns for ongoing continued use among clinicians and patients.. This review highlights the most recent information around these controversies and provides evidence summaries to help guide care providers in their care plans as well as discussions with patients.

Topics: Anti-Ulcer Agents; Bone Density; Calcium, Dietary; Gastroesophageal Reflux; Humans; Iron; Malabsorption Syndromes; Practice Guidelines as Topic; Practice Patterns, Physicians'; Proton Pump Inhibitors; United States; Vitamin B 12; Vitamins

Proton pump inhibitors (PPIs) are one of the most commonly prescribed drug groups in developed countries. Their approved indications include gastroesophageal reflux disease, peptic ulcer disease, and prophylaxis against NSAID-induced gastroenteropathy in specific scenarios. Since their introduction into clinical practice, their usage has significantly increased, leading to concerns about possible inappropriate prescribing, which can result in a higher risk of side effects and increased economic costs. Consequently, in recent years, literature linking PPIs to various adverse effects has emerged, with some supported by robust evidence, while others are based on lower-quality evidence, requiring cautious interpretation. Among the adverse effects of PPIs, significant ones include an increased risk of fragility fractures, deficiencies in certain micronutrients such as vitamin B12 and magnesium, a higher incidence of enteric infections, especially Clostridioides difficile, complications in cirrhotic patients, and pharmacological interactions with other medications. In clinical practice, it is essential to periodically evaluate the rationale for prescribing these drugs and consider discontinuing them if there is no appropriate indication. Despite PPIs being generally safe medications, it is crucial to be aware of their potential adverse effects and appropriate indications to ensure their proper use.

Topics: Gastroesophageal Reflux; Gastrointestinal Diseases; Humans; Peptic Ulcer; Proton Pump Inhibitors; Vitamin B 12

Double tract anastomosis (DTA) is a recently revisited reconstruction method for preventing reflux esophagitis in laparoscopy-assisted proximal gastrectomy (LAPG). However, only few studies have shown the advantages of LAPG-DTA.. Seventeen patients underwent LAPG-DTA compared to 17 patients undergoing laparoscopy-assisted total gastrectomy (LATG) matched with preoperative stage. Laboratory results, including hemoglobin, serum ferritin, serum iron and vitamin B12, were compared.. Reflux esophagitis developed in two and one patient in the LAPG-DTA and LATG groups, respectively. In the laboratory analysis, fewer patients experienced decrease of serum ferritin below the low normal limit in the LAPG-DTA group. There was a significantly lower proportion of patients in the LAPG-DTA group whose vitamin B12 level decreased below the low normal limit.. LAPG-DTA has the advantages of allowing absorption of iron and vitamin B12 without reflux esophagitis in proximal early gastric cancer compared to LATG.

Topics: Aged; Anastomosis, Surgical; Female; Gastrectomy; Gastroesophageal Reflux; Humans; Iron; Laparoscopy; Male; Middle Aged; Postoperative Complications; Stomach Neoplasms; Vitamin B 12

Topics: Fractures, Bone; Gastroesophageal Reflux; Humans; Proton Pump Inhibitors; Vitamin B 12; Vitamin B 12 Deficiency

Topics: Anti-Ulcer Agents; Gastroesophageal Reflux; Histamine H2 Antagonists; Humans; Intestinal Absorption; Vitamin B 12; Vitamin B 12 Deficiency

Topics: Adenocarcinoma; Adult; Age Distribution; Age Factors; Aged; Aged, 80 and over; Aspirin; Barrett Esophagus; Clopidogrel; Drug Interactions; Drug Prescriptions; Esophageal Neoplasms; Esophagitis; Esophagoscopy; Gastroesophageal Reflux; Gastroscopy; Heartburn; Hip Fractures; Humans; Intestinal Absorption; Middle Aged; Obesity; Odds Ratio; Platelet Aggregation Inhibitors; Population Surveillance; Prevalence; Proton Pump Inhibitors; Ticlopidine; Vitamin B 12

Topics: 2-Pyridinylmethylsulfinylbenzimidazoles; Adolescent; Bone Density; Calcium; Child; Child, Preschool; Female; Gastroesophageal Reflux; Hemoglobins; Humans; Iron; Lansoprazole; Male; Proton Pump Inhibitors; Time Factors; Vitamin B 12

To report a case of vitamin B(12) deficiency associated with long-term use (approximately 4 1/2 y) of histamine(2) (H(2))-receptor antagonists and a proton-pump inhibitor (PPI) in a patient with gastroesophageal reflux.. A 78-year-old nonvegetarian white woman with symptomatic gastroesophageal reflux (GER) was started on cimetidine 300 mg 4 times daily in February 1990 and took various other antisecretory medications over the course of the next 4 1/2 years. She had a normal serum vitamin B(12) concentration of 413 pg/mL in August 1992. In June 1994, her serum vitamin B(12) concentration was found to be in the low normal range at 256 pg/mL. Biochemical markers of vitamin B(12)-dependent enzyme activity were measured at that time, and methylmalonic acid (MMA) and homocysteine (HCYS) were elevated at 757 nmol/L and 27.3 micromol/L, respectively. Serum folate was within the normal range at 4.9 ng/mL, and serum creatinine was slightly elevated at 1.4 mg/dL. MMA and HCYS concentrations decreased dramatically with oral replacement of vitamin B(12) 1000 microg/d, which confirmed vitamin B(12) deficiency. Oral replacement also demonstrated that the woman was able to adequately absorb nonprotein-bound vitamin B(12) from the gastrointestinal tract, suggesting that her deficiency was a result of food-cobalamin malabsorption. The accumulation of MMA and HCYS was not a consequence of renal dysfunction, since both metabolites dramatically decreased with vitamin B(12) replacement.. Malabsorption of dietary protein-bound vitamin B(12) has been demonstrated with the use of H(2)-receptor antagonists and PPIs. One previous case report of vitamin B(12) deficiency resulting from long-term use of omeprazole has been published. The malabsorption of dietary vitamin B(12) is thought to be a result of its impaired release from food protein, which requires gastric acid and pepsin as the initial step in the absorption process.. The use of H(2)-receptor antagonists and/or PPIs may impair the absorption of protein-bound dietary vitamin B(12) and could contribute to the development of vitamin B(12) deficiency with prolonged use. Patients taking these medications for extended periods of time, particularly >4 years, should be monitored for vitamin B(12) status.

Topics: Aged; Cimetidine; Creatinine; Enzyme Inhibitors; Female; Folic Acid; Gastroesophageal Reflux; Histamine H2 Antagonists; Homocysteine; Humans; Methylmalonic Acid; Omeprazole; Proton Pump Inhibitors; Vitamin B 12; Vitamin B 12 Deficiency

Omeprazole maintenance therapy for gastro-oesophageal reflux disease (GERD) has been associated with an increased incidence of atrophic gastritis in H. pylori-infected patients and with a decreased absorption of protein-bound, but not of unbound cobalamin.. : To test the hypothesis that the combination of decreased cobalamin absorption and atrophic gastritis decreases serum cobalamin levels during omeprazole therapy.. Forty-nine H. pylori-positive GERD patients were treated with omeprazole for a mean (+/- s.d.) period of 61 (25) months. At the start of omeprazole treatment (T0) and at the latest follow-up visit (T1), serum was obtained for measurement of cobalamin. Corpus biopsy specimens were obtained at entry and follow-up for histopathological scoring according to the updated Sydney classification.. At inclusion, none of the 49 patients had signs of atrophic gastritis. During follow-up, 15 patients (33%) developed atrophic gastritis, nine of whom had moderate to severe atrophy. These 15 patients did not differ from the other 34 patients with respect to age, serum cobalamin at T0 or the duration of follow-up. During follow-up, no change was observed in the median serum cobalamin level in the 34 patients without atrophy; (T0) 312 (136-716) vs. (T1) 341 (136-839) pmol/L (P=0.1). In the 15 patients who developed atrophy, a decrease in cobalamin was seen from 340 (171 to 787) at baseline to 285 (156-716) at latest follow-up (P < 0.01).. The development of atrophic gastritis during omeprazole treatment in H. pylori-positive GERD patients is associated with a decrease of serum vitamin B12 levels.

Topics: Absorption; Anti-Ulcer Agents; Cohort Studies; Drug Administration Schedule; Female; Gastritis, Atrophic; Gastroesophageal Reflux; Humans; Longitudinal Studies; Male; Middle Aged; Omeprazole; Prospective Studies; Vitamin B 12

The first case of cobalamin deficiency with megaloblastic anaemia in a patient under long-term omeprazole therapy is presented. This patient received omeprazole at a daily dose of 40-60 mg for 4 years as treatment for a gastro-oesophagal reflux complicated by peptic oesophagitis. Seric vitamin B12 was dramatically decreased at 80 pmol L-1. The Schilling test was normal (13%) with crystalline [57Co] cobalamin and it was at 0% with [57Co] cobalamin-labelled trout meat. All other assimilation tests were normal except an expiratory hydrogen breath test performed with lactulose. The haematological status was restored after intramuscular treatment with cobalamin. In conclusion, prolonged omeprazole therapy can be responsible for a cobalamin deficiency due to protein-bound cobalamin malabsorption.

Topics: Anemia, Megaloblastic; Enzyme Inhibitors; Gastroesophageal Reflux; Hematinics; Humans; Malabsorption Syndromes; Male; Middle Aged; Omeprazole; Schilling Test; Vitamin B 12; Vitamin B 12 Deficiency

Topics: Celiac Disease; Diarrhea; Dumping Syndrome; Enzyme Therapy; Folic Acid; Gastrectomy; Gastroesophageal Reflux; Humans; Iron; Male; Middle Aged; Postoperative Care; Postoperative Complications; Tranquilizing Agents; Vitamin B 12