JAMDA
Volume 9, Issue 3 , Pages 162-167 , March 2008

Do Acid-Lowering Agents Affect Vitamin B12 Status in Older Adults?

This work was presented, in part, at the American Medical Directors Association Annual Meeting in 2006: Dharmarajan TS, Lebelt AS, Murakonda P, Kanagala M, Norkus EP. Do acid-lowering agents decrease vitamin B12 status in older adults from the community and nursing homes? JAMDA, 2006;7: B15. Winner, Howard Gutterman Award, AMDA, March 2006.

  • T.S. Dharmarajan, MD, FACP, AGSF

      Affiliations

    • Department of Medicine, Our Lady of Mercy Medical Center, Bronx, NY
    • Division of Geriatrics, Our Lady of Mercy Mecial Center, Bronx, NY
    • Corresponding Author InformationAddress correspondence to T.S. Dharmarajan, MD, 31 Pheasant Run, Scarsdale, NY 10583.
    • ,
  • Madhusudhana R. Kanagala, MD

      Affiliations

    • Division of Geriatrics, Our Lady of Mercy Mecial Center, Bronx, NY
    • ,
  • Padmavathi Murakonda, MD

      Affiliations

    • Division of Geriatrics, Our Lady of Mercy Mecial Center, Bronx, NY
    • ,
  • Ahna S. Lebelt, MD

      Affiliations

    • Division of Geriatrics, Our Lady of Mercy Mecial Center, Bronx, NY
    • ,
  • Edward P. Norkus, PhD, FACN

      Affiliations

    • Department of Medical Research, Our Lady of Mercy Medical Center, Bronx, NY.

References 

  1. Dharmarajan TS, Norkus EP. Vitamin B12 deficiency in the elderly—population based research. In:  Herbert V editors. Vitamin B12 Deficiency. London: Royal Society of Medicine Press; 1999;p. 27–34
  2. Carmel R. Cobalamin, the stomach and aging. Am J Clin Nutr. 1997;66:750–759
  3. Stabler SP, Lindenbaum J, Allen RH. Vitamin B12 deficiency in the elderly: Current dilemmas. Am J Clin Nutr. 1997;66:741–749
  4. Ho C, Gail P, Kauwell A, Bailey LB. Practitioners’ guide to meeting the vitamin B12 recommended dietary allowance for people aged 51 years and older. J Am Diet Assn. 1999;99:725–727
  5. Dharmarajan TS, Ugalino JT, Kanagala M, Norkus EP. Vitamin B12 status in hospitalized elderly from nursing homes and community. J Am Med Dir Assoc. 2000;1:21–24
  6. Dharmarajan TS, Adiga GU, Norkus EP. Vitamin B12 deficiency: Recognizing subtle symptoms in older adults. Geriatrics. 2003;58:30–38
  7. Dharmarajan TS, Norkus EP. Approaches to vitamin B12 deficiency. PostGrad Med. 2001;110:99–106
  8. Steinberg WM, King CE, Toskes PP. Malabsorption of protein-bound cobalamin but not unbound cobalamin during cimetidine administration. Dig Dis Sci. 1980;25:188–191
  9. Salom IL, Silvis SE, Doscherholmen A. Effect of cimetidine on the absorption of vitamin B12. Scand J Gastroenterol. 1982;17:129–131
  10. Belaiche J, Zittoun J, Marquet J, Nurit Y, Yvart J. Effect of ranitidine on secretion of gastric intrinsic factor and absorption of vitamin B12. Gastroenterol Clin Biol. 1983;7:381–384
  11. Marcuard SP, Albernaz L, Khazanie PG. Omeprazole therapy causes malabsorption of cyanocobalamin (vitamin B12). Ann Intern Med. 1994;120:211–215
  12. Termanini B, Gibril F, Sutliff VE, Yu F, Venzon DJ, Jensen RT. Effect of long-term gastric acid suppressive therapy on serum vitamin B12 levels in patients with Zollinger-Ellison syndrome. Am J Med. 1998;104:422–430
  13. Ruscin JM, Page RL, Valuck RJ. Vitamin B12 deficiency associated with histamine2-receptor antagonists and a proton-pump inhibitor. Ann Pharmacother. 2002;36:812–816
  14. Valuck RJ, Ruscin JM. A case-control study on adverse effects: H2 blocker or proton pump inhibitor use and the risk of vitamin B12 deficiency in older adults. J Clin Epidemiol. 2004;57:422–428
  15. Hamborg B, Kittang E, Schjonsby H. The effect of ranitidine on the absorption of food cobalamin. Scand J Gastroenterol. 1985;20:756–758
  16. Koop H. Metabolic consequences of long-term inhibition of acid secretion by omeprazole. Ailment Pharmacol Ther. 1992;6:399–406
  17. Koop H, Bachem MG. Serum iron, ferritin, and vitamin B12 during prolonged omeprazole therapy. J Clin Gastroenterol. 1992;14:288–292
  18. Schenk BE, Festen HP, Kuipers J, Klinkenberg-Knol EC, Meuwissen S. Effect of short- and long-term treatment with omeprazole on the absorption and serum levels of cobalamin. Ailment Pharmacol Ther. 1996;10:541–545
  19. Howden CW. Vitamin B12 levels during prolonged treatment with proton pump inhibitors. J Clin Gastroenterol. 2000;30:29–33
  20. Richter JE. Should patients receiving long-term gastric acid inhibition therapy be evaluated for vitamin B12 deficiency?. Clev Clin J Med. 2000;67:785–787
  21. Stabler SP. Screening the older population for cobalamin (vitamin B12) deficiency. J Am Geriatr Soc. 1995;43:1290–1297
  22. Snow CF. Laboratory diagnosis of vitamin B12 and folate deficiency. Arch Intern Med. 1999;159:1289–1298
  23. Pham CQD, Sadowski-Hayes LM, Regal RE. Prevalent prescribing of proton pump inhibitors: prudent or pernicious?. Pharmacy and Therapeutics. 2006;31:159–167
  24. Chong E, Ensom MHH. Pharmacogenetics of the proton pump inhibitors: a systematic review. Pharmacotherapy. 2003;23:460–471

 This study was internally funded as part of the Geriatric Medicine Fellowship program. The authors do not have any conflict of interest (grant or financial support) regarding the submission and publication of this report.

PII: S1525-8610(07)00461-6

doi: 10.1016/j.jamda.2007.10.004

JAMDA
Volume 9, Issue 3 , Pages 162-167 , March 2008

Article Tools

* Image Usage & Resolution