Advertisement

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

      Objective

      To examine the relationship between serum vitamin B12 levels in older adults on histamine2 receptor antagonists (H2 blockers) or proton-pump inhibitors (PPI) over 6 years. Participants: A cross-sectional sample of 659 adults, 60 to 102 years, from long-term care facilities and community ambulatory care (C) in the Bronx.

      Measurements

      Patient demographics, serum B12 levels, use and duration of use of H2 blockers, PPIs, antacids, multivitamin/minerals, liquid dietary supplements, oral vitamin B12 supplementation, oral or intramuscular B12 therapy, and recent lab chemistries.

      Results

      Acid-lowering agents (ALA) were used by 54% (PPIs by 26% and H2 blockers by 28%), duration averaged 18.2 ± 16.0 (SD) months. NH and C subjects had similar ages (P = .9971), gender distributions (P = .625), durations of ALA use (P = .1227), and rates of PPI use (P = .130); NH subjects used more H2 blockers (P < .0005) and had less low B12 status (P = .037). H2 blocker use did not influence serum B12 status (P = .1036) while PPI use was associated with diminished serum B12 levels (P < .00005). Concomitant oral B12 supplementation slowed but did not prevent the decline in B12 status during prolonged PPI use (P = .0125).

      Conclusions

      B12 status declines during prolonged PPI use in older adults, but not with prolonged H2 blocker use; supplementation with RDA amounts of B12 do not prevent this decline. This report reinforces that B12 deficiency is common in the elderly and suggests that it appears prudent to monitor periodically B12 status while on prolonged PPI use, to enable correction before complications ensue.

      Keywords

      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'

      Subscribe:

      Subscribe to Journal of the American Medical Directors Association
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect

      References

        • Dharmarajan T.S.
        • Norkus E.P.
        Vitamin B12 deficiency in the elderly—population based research.
        in: Herbert V. Vitamin B12 Deficiency. Royal Society of Medicine Press, London1999: 27-34
        • Carmel R.
        Cobalamin, the stomach and aging.
        Am J Clin Nutr. 1997; 66: 750-759
        • Stabler S.P.
        • Lindenbaum J.
        • Allen R.H.
        Vitamin B12 deficiency in the elderly: Current dilemmas.
        Am J Clin Nutr. 1997; 66: 741-749
        • Ho C.
        • Gail P.
        • Kauwell A.
        • Bailey L.B.
        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
        • Dharmarajan T.S.
        • Ugalino J.T.
        • Kanagala M.
        • Norkus E.P.
        Vitamin B12 status in hospitalized elderly from nursing homes and community.
        J Am Med Dir Assoc. 2000; 1: 21-24
        • Dharmarajan T.S.
        • Adiga G.U.
        • Norkus E.P.
        Vitamin B12 deficiency: Recognizing subtle symptoms in older adults.
        Geriatrics. 2003; 58: 30-38
        • Dharmarajan T.S.
        • Norkus E.P.
        Approaches to vitamin B12 deficiency.
        PostGrad Med. 2001; 110: 99-106
        • Steinberg W.M.
        • King C.E.
        • Toskes P.P.
        Malabsorption of protein-bound cobalamin but not unbound cobalamin during cimetidine administration.
        Dig Dis Sci. 1980; 25: 188-191
        • Salom I.L.
        • Silvis S.E.
        • Doscherholmen A.
        Effect of cimetidine on the absorption of vitamin B12.
        Scand J Gastroenterol. 1982; 17: 129-131
        • 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
        • Marcuard S.P.
        • Albernaz L.
        • Khazanie P.G.
        Omeprazole therapy causes malabsorption of cyanocobalamin (vitamin B12).
        Ann Intern Med. 1994; 120: 211-215
        • Termanini B.
        • Gibril F.
        • Sutliff V.E.
        • Yu F.
        • Venzon D.J.
        • Jensen R.T.
        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
        • Ruscin J.M.
        • Page R.L.
        • Valuck R.J.
        Vitamin B12 deficiency associated with histamine2-receptor antagonists and a proton-pump inhibitor.
        Ann Pharmacother. 2002; 36: 812-816
        • Valuck R.J.
        • Ruscin J.M.
        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
        • Hamborg B.
        • Kittang E.
        • Schjonsby H.
        The effect of ranitidine on the absorption of food cobalamin.
        Scand J Gastroenterol. 1985; 20: 756-758
        • Koop H.
        Metabolic consequences of long-term inhibition of acid secretion by omeprazole.
        Ailment Pharmacol Ther. 1992; 6: 399-406
        • Koop H.
        • Bachem M.G.
        Serum iron, ferritin, and vitamin B12 during prolonged omeprazole therapy.
        J Clin Gastroenterol. 1992; 14: 288-292
        • Schenk B.E.
        • Festen H.P.
        • Kuipers J.
        • Klinkenberg-Knol E.C.
        • 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
        • Howden C.W.
        Vitamin B12 levels during prolonged treatment with proton pump inhibitors.
        J Clin Gastroenterol. 2000; 30: 29-33
        • Richter J.E.
        Should patients receiving long-term gastric acid inhibition therapy be evaluated for vitamin B12 deficiency?.
        Clev Clin J Med. 2000; 67: 785-787
        • Stabler S.P.
        Screening the older population for cobalamin (vitamin B12) deficiency.
        J Am Geriatr Soc. 1995; 43: 1290-1297
        • Snow C.F.
        Laboratory diagnosis of vitamin B12 and folate deficiency.
        Arch Intern Med. 1999; 159: 1289-1298
        • Pham C.Q.D.
        • Sadowski-Hayes L.M.
        • Regal R.E.
        Prevalent prescribing of proton pump inhibitors: prudent or pernicious?.
        Pharmacy and Therapeutics. 2006; 31: 159-167
        • Chong E.
        • Ensom M.H.H.
        Pharmacogenetics of the proton pump inhibitors: a systematic review.
        Pharmacotherapy. 2003; 23: 460-471