Original ResearchFull Report: Clinical—Alimentary TractProton Pump Inhibitor and Histamine-2 Receptor Antagonist Use and Iron Deficiency
Section snippets
Study Population
We conducted a nested case-control study within the Kaiser Permanente, Northern California (KPNC) health care system, which provides comprehensive services to approximately 3.7 million members. The KPNC membership approximates the underlying census race/ethnicity and socioeconomic distributions of the region.13 Prescription drug benefits are utilized by >90% of members; databases electronically record dispense dates, dose, amount, directions for use, days supply, and refills for all
Results
We identified 334,683 members with an incident diagnosis of iron deficiency between January 1, 1999 and December 31, 2013. We excluded the following subjects: potential cases lacking matched controls (n = 59); potential cases (n = 225,779) and controls with the listed exclusion conditions; cases (n = 7321) and controls who received <2 years supply of PPIs or H2RAs; cases (n = 14) and controls who, despite having been dispensed ≥2 years supply of PPIs or H2RAs had taken them for <2 years of
Discussion
In the present study, the use of acid-inhibiting medications for at least 2 years was associated with a subsequent new diagnosis of iron deficiency. The magnitude of the association was stronger among younger age groups, with more potent acid suppression (PPIs vs H2RAs) and for higher doses of PPIs, and weaker after discontinuation of use. Differences were primarily found with transitions from no exposure to lower potency (H2RA) medications, from lower potency to higher potency medications
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Conflicts of interest This author discloses the following: Douglas A. Corley has received funding from Pfizer. The remaining authors disclose no conflicts.
Funding This work was supported by a Kaiser Permanente Community Benefits Grant. The funding source had no role in the design and conduct of the study; in the collection, management, analysis, and interpretation of the data; and preparation, review, or approval of the manuscript; and decision to submit the manuscript for publication.