Effect of Omeprazole on Response to Oral Ferrous Sulphate in Iron Deficient Patients: 2010 Presidential Poster

Abstract

Purpose: Proton pump inhibitors are very commonly prescribed medications in gastrointestinal practice. One of the debated effects of proton pump inhibitors is on oral iron absorption. Their effect on absorption of oral iron supplementation in iron deficient patients has not been studied. Methods: We reviewed patient charts seen in Cooper Outpatient offices for iron deficiency anemia on omeprazole within the last three years. We then selected fifty patients based on following criteria: Having no apparent ongoing blood loss; having other causes of anemia especially that of chronic disease ruled out; and had follow-up iron studies done. The iron studies at the start of oral ferrous sulfate therapy and at three months follow up were compared to evaluate the response. Results: There were 74% males and 36% females in the study group. Mean age of the study group was 50.5+/-15.3 years. Mean hemoglobin and ferritin at baseline, and at three months follow up along with their paired t-test results and p-values are shown in table 1. The mean hemoglobin change was 0.8+/-1.2 g/L, while the mean ferritin change was 10.2+/-7.8 ug/L. These results indicate that there was a significant change in both hemoglobin and ferritin levels. But only 40% of the patients had a normal response to ferritin levels, defined as a rise of >20 ug/L; and only 15% had a normal response to hemoglobin levels; defined as a rise of > 2 g/L. Also on further follow up almost all who were continued on iron and omeprazole achieved a normal ferritin and hemoglobin levels in a year. Also 15 patients were switched to iv iron therapy and 13 of them responded. Further 5 patients had no compelling reason to be on omeprazole and 4 of them responded to ferrous sulfate after stopping omeprazole. Conclusion: Omeprazole and possibly all proton pump inhibitors seem to decrease the absorption of oral iron supplementation, to a level where either they may have to be continued for a long term or may have to be given the iron supplementation intravenously. Patients who need to be on long term PPI, especially who may have ongoing occult blood loss should be checked regularly for iron deficiency anemia, as they most certainly also significantly decrease dietary iron absorption. And if found to be iron deficient, they should either be treated with high dose iron therapy or for susceptible patients with iv iron therapy. Further, prospective studies are needed to support this preliminary finding.Table: Serum hemoglobin and ferritin levels before and after oral iron supplementation