Proton Pump Inhibitor Use and Iron Deficiency Anemia in Celiac Patients

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.

This is the accepted manuscript version of an article published by S. Karger AG in [Proton Pump Inhibitor Use and Iron Deficiency Anemia in Celiac Patients. Digestive Diseases p25-30 (2024)] and available on www.karger.com/Article/FullText/10.1159/000534800

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Work Title Proton Pump Inhibitor Use and Iron Deficiency Anemia in Celiac Patients
Access
Open Access
Creators
  1. Stephanie Hawkins
  2. Meghali Nighot
  3. Shannon Dalessio
  4. Junjia Zhu
  5. Nathan Morris
  6. Kofi Clarke
Keyword
  1. Celiac disease
  2. Iron deficiency anemia
  3. Proton pump inhibitors
License In Copyright (Rights Reserved)
Work Type Article
Publisher
  1. Digestive Diseases
Publication Date November 8, 2023
Publisher Identifier (DOI)
  1. https://doi.org/10.1159/000534800
Deposited March 15, 2024

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Version 1
published

  • Created
  • Added Manuscript-Accept_MS.docx
  • Added Table-Table_1.docx
  • Added Figure-Figure_1.png
  • Added Figure-Figure_2.png
  • Added Figure-Figure_3.png
  • Added Creator Stephanie Hawkins
  • Added Creator Meghali Nighot
  • Added Creator Shannon Dalessio
  • Added Creator Junjia Zhu
  • Added Creator Nathan Morris
  • Added Creator Kofi Clarke
  • Published
  • Updated Keyword, Description, Publication Date Show Changes
    Keyword
    • Celiac disease, Iron deficiency anemia, Proton pump inhibitors
    Description
    • <p>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 &lt; 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.</p>
    • <p>**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 &lt; 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.</p>
    Publication Date
    • 2024-01-01
    • 2023-11-08
  • Updated