Introduction: We sought to evaluate the effect of proton pump inhibitor (PPI) use on the development and severity of iron deficiency anemia (IDA) in celiac disease (CD). Methods: We conducted a retrospective chart review of patients older than 18 years of age at Milton S. Hershey Medical Center who were diagnosed with CD. We analyzed four cohorts of celiac patients: (1) IDA diagnosis with PPI usage, (2) no IDA diagnosis with PPI usage, (3) IDA diagnosis with no PPI usage, and (4) no IDA diagnosis with no PPI usage. We also stratified celiac patients with IDA by anemia severity. Results: Of 366 celiac patients, 92 (25.1%) were diagnosed with IDA, of which 60 (65.2%) were on a PPI. The mean Hgb of celiac patients with IDA on a PPI was 11.1 g/dL and 12.1 g/dL for those without PPI (p = 0.04). For all celiac patients on a PPI without IDA, the mean was 13.3 g/dL and 13.7 g/dL for those without PPI (p = 0.02). PPI use occurred in 12 (70.6%) of the 17 patients with low severity anemia, 11 (64.7%) of the 17 patients with medium severity and 6 (85.7%) of the 7 patients with severe (p = 0.55). Conclusions: There is significant association between PPI use and IDA in celiac patients (p < 0.0001). Of those with IDA on PPIs, the distribution of the severity of anemia is not statistically different compared to those not on PPI. Discontinuation of PPIs or usage of alternative acid suppressive treatments may be indicated in patients with CD and iron deficiency anemia.

1.
Green
PH
,
Jabri
B
.
Coeliac disease
.
Lancet
.
2003
;
362
(
9381
):
383
91
.
2.
Halfdanarson
TR
,
Litzow
MR
,
Murray
JA
.
Hematologic manifestations of celiac disease
.
Blood
.
2007
;
109
(
2
):
412
21
.
3.
Freeman
HJ
.
Iron deficiency anemia in celiac disease
.
World J Gastroenterol
.
2015
;
21
(
31
):
9233
8
.
4.
Stefanelli
G
,
Viscido
A
,
Longo
S
,
Magistroni
M
,
Latella
G
.
Persistent iron deficiency anemia in patients with celiac disease despite a gluten-free diet
.
Nutrients
.
2020
;
12
(
8
):
2176
.
5.
Shin
JM
,
Sachs
G
.
Pharmacology of proton pump inhibitors
.
Curr Gastroenterol Rep
.
2008
;
10
(
6
):
528
34
.
6.
Lopez
A
,
Cacoub
P
,
Macdougall
IC
,
Peyrin-Biroulet
L
.
Iron deficiency anaemia
.
Lancet
.
2016
;
387
(
10021
):
907
16
.
7.
Rhodes
RA
,
Tai
H-H
,
Chey
WY
.
Impairment of secretin release in celiac sprue
.
Am J Dig Dis
.
1978
;
23
(
9
):
833
9
.
8.
Maton
PN
,
Selden
AC
,
Fitzpatrick
ML
,
Chadwick
VS
.
Defective gallbladder emptying and cholecystokinin release in celiac disease. Reversal by gluten-free diet
.
Gastroenterology
.
1985
;
88
(
2
):
391
6
.
9.
Leffler
DA
,
Kelly
CP
.
Celiac disease and gastroesophageal reflux disease: yet another presentation for a clinical chameleon
.
Clin Gastroenterol Hepatol
.
2011
;
9
(
3
):
192
3
.
10.
Nachman
F
,
Vázquez
H
,
González
A
,
Andrenacci
P
,
Compagni
L
,
Reyes
H
.
Gastroesophageal reflux symptoms in patients with celiac disease and the effects of a gluten-free diet
.
Clin Gastroenterol Hepatol
.
2011
;
9
(
3
):
214
9
.
11.
Nighot
M
,
Liao
PL
,
Morris
N
,
McCarthy
D
,
Dharmaprakash
V
,
Ullah Khan
I
.
Long-Term use of proton pump inhibitors disrupts intestinal tight junction barrier and exaggerates experimental colitis
.
J Crohns Colitis
.
2023
;
17
(
4
):
565
79
.
12.
Sarzynski
E
,
Puttarajappa
C
,
Xie
Y
,
Grover
M
,
Laird-Fick
H
.
Association between proton pump inhibitor use and anemia: a retrospective cohort study
.
Dig Dis Sci
.
2011
;
56
(
8
):
2349
53
.
13.
Dado
DN
,
Loesch
EB
,
Jaganathan
SP
.
A case of severe iron deficiency anemia associated with long-term proton pump inhibitor use
.
Curr Ther Res Clin Exp
.
2017
;
84
:
1
3
.
14.
Lam
JR
,
Schneider
JL
,
Quesenberry
CP
,
Corley
DA
.
Proton pump inhibitor and histamine-2 receptor antagonist use and iron deficiency
.
Gastroenterology
.
2017
;
152
(
4
):
821
9.e1
.
15.
Sharma
VR
,
Brannon
MA
,
Carloss
EA
.
Effect of omeprazole on oral iron replacement in patients with iron deficiency anemia
.
South Med J
.
2004
;
97
(
9
):
887
9
.
16.
Shikata
T
,
Sasaki
N
,
Ueda
M
,
Kimura
T
,
Itohara
K
,
Sugahara
M
.
Use of proton pump inhibitors is associated with anemia in cardiovascular outpatients
.
Circ J
.
2015
;
79
(
1
):
193
200
.
17.
Qorraj-Bytyqi
H
,
Hoxha
R
,
Sadiku
S
,
Bajraktari
IH
,
Sopjani
M
,
Thaçi
K
.
Proton pump inhibitors intake and iron and vitamin B12 status: a prospective comparative study with a follow up of 12 months
.
Open Access Maced J Med Sci
.
2018
;
6
(
3
):
442
6
.
18.
Tran-Duy
A
,
Connell
NJ
,
Vanmolkot
FH
,
Souverein
PC
,
de Wit
NJ
,
Stehouwer
CDA
.
Use of proton pump inhibitors and risk of iron deficiency: a population-based case-control study
.
J Intern Med
.
2019
;
285
(
2
):
205
14
.
19.
Freedberg
DE
,
Kim
LS
,
Yang
YX
.
The risks and benefits of long-term use of proton pump inhibitors: expert review and best practice advice from the American gastroenterological association
.
Gastroenterology
.
2017
;
152
(
4
):
706
15
.
20.
Walker
NM
,
McDonald
J
.
An evaluation of the use of proton pump inhibitors
.
Pharm World Sci
.
2001
;
23
(
3
):
116
7
.
21.
Pham
CQ
,
Regal
RE
,
Bostwick
TR
,
Knauf
KS
.
Acid suppressive therapy use on an inpatient internal medicine service
.
Ann Pharmacother
.
2006 Jul–Aug
40
7–8
1261
6
.
22.
Batuwitage
BT
,
Kingham
JG
,
Morgan
NE
,
Bartlett
RL
.
Inappropriate prescribing of proton pump inhibitors in primary care
.
Postgrad Med J
.
2007
;
83
(
975
):
66
8
.
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