Proton Pump Inhibitor Use and the Ability to Replete Iron Stores

Blood ◽  
2011 ◽  
Vol 118 (21) ◽  
pp. 1039-1039
Author(s):  
Alina M Huang ◽  
Christine M Ho ◽  
John L. Reagan ◽  
Eric Winer
Keyword(s):  
Iron Deficiency ◽  
Iron Deficiency Anemia ◽  
Proton Pump ◽  
Iron Absorption ◽  
Oral Iron ◽  
Deficiency Anemia ◽  
Care Clinic ◽  
Iron Stores ◽  
Iron Deficient ◽  
Iron Replacement

Abstract Abstract 1039 Background: Oral iron absorption occurs in the duodenum and requires increased gastric acidity to allow iron to remain in the more soluble, ferrous form. Many patients with iron deficiency anemia who require oral iron repletion are on proton pump inhibitors (PPIs) for management of various conditions that require acid suppression for treatment. In vitro studies suggest that inhibition of gastric acid secretion decreases the bioavailability of iron. In patients with established iron deficiency anemia who are on PPIs, there is a paucity of data regarding the efficacy of iron replacement with concomitant PPI use. Sharma et al. published a case report on 2 patients who were iron deficient and on PPI therapy (Sharma et. al. Southern Medical Journal 2004). Their findings showed that discontinuation of the PPI resulted in improvement of iron deficiency anemia on the same dose of oral iron replacement. Additionally, Hutchinson et al. demonstrated that in individuals with hereditary hemachromatosis, those on PPIs had a significant reduction in phlebotomy requirements needed to keep serum ferritin ∼50μg (Hutchinson et. al. Gut 2007). We conducted a retrospective study to assess whether a difference exists in terms of iron repletion between patients on a PPI versus those not on a PPI. Methods: Patients were selected from the medical primary care clinic from charts dating January 2000 until January 2009. Included patients were adults older than 18 years of age, a diagnosis of iron deficiency based on ferritin < 30 with at least one follow up ferritin value, and recipients of oral iron replacement. Excluded patients were those with chronic active bleeding and anemia of chronic disease. Indices examined include iron (Fe), total iron binding capacity (TIBC), ferritin, transferrin saturation, hemoglobin (Hb), hematocrit (Hct), and mean corpuscular volume (MCV). The primary endpoint of interest is repletion of iron stores defined by ferritin > 30. Those who were able to replete their iron stores are termed “responders” and those who were not are termed “nonresponders”. Results: Forty-five patients have been identified who have met the above criteria. Of these patients, 14 were on a PPI and 31 were not on a PPI. Of the patients not on a PPI, 38.7% responded to oral iron. Of the patients on a PPI, 50.0% responded to oral iron. The average initial and final values of indices of interest were compared between the groups (Table 1). Discussion: Our data suggests that patients both on and off PPIs show the ability to replete their iron stores. Furthermore, it appears that a slightly greater percentage of patients on a PPI compared with those not on a PPI are able to replete their iron stores, though the numbers remain small. Most importantly, these findings challenge the commonly held belief that PPI use impairs oral iron absorption. A prospective study is warranted to further confirm these observational data. Disclosures: No relevant conflicts of interest to declare.

scholarly journals IRON ABSORPTION AND RESPONSE TO ORAL IRON THERAPY IN IRON DEFICIENCY ANEMIA ASSOCIATED TO ASYMPTOMATIC GIARDIASIS.

1993 ◽  
Vol 33 (6) ◽  
pp. 661-661
Author(s):  
Helena U Suzuki ◽  
Mauro B Morais ◽  
Jose N Corral ◽  
Ulisses Fagundes-Neto ◽  
Nelson L Machado
Keyword(s):  
Iron Deficiency ◽  
Iron Deficiency Anemia ◽  
Iron Absorption ◽  
Oral Iron ◽  
Iron Therapy ◽  
Deficiency Anemia ◽  
Oral Iron Therapy

scholarly journals Iron supplementation in goitrous, iron-deficient children improves their response to oral iodized oil

2000 ◽  
pp. 217-223 ◽  
Author(s):  
M Zimmermann ◽  
P Adou ◽  
T Torresani ◽  
C Zeder ◽  
R Hurrell
Keyword(s):  
Iron Deficiency ◽  
Iron Deficiency Anemia ◽  
Iron Supplementation ◽  
Thyroid Volume ◽  
Oral Iron ◽  
Deficiency Anemia ◽  
Urinary Iodine Concentration ◽  
Iodized Oil ◽  
Iron Deficient ◽  
Group 2

OBJECTIVE: In developing countries, many children are at high risk for both goiter and iron-deficiency anemia. Because iron deficiency may impair thyroid metabolism, the aim of this study was to determine if iron supplementation improves the response to oral iodine in goitrous, iron-deficient anemic children. DESIGN: A trial of oral iodized oil followed by oral iron supplementation in an area of endemic goiter in the western Ivory Coast. METHODS: Goitrous, iodine-deficient children (aged 6-12 years; n=109) were divided into two groups: Group 1 consisted of goitrous children who were not anemic; Group 2 consisted of goitrous children who were iron-deficient anemic. Both groups were given 200mg oral iodine as iodized oil. Thyroid gland volume using ultrasound, urinary iodine concentration (UI), serum thyroxine (T(4)) and whole blood TSH were measured at baseline, and at 1, 5, 10, 15 and 30 weeks post intervention. Beginning at 30 weeks, the anemic group was given 60mg oral iron as ferrous sulfate four times/week for 12 weeks. At 50 and 65 weeks after oral iodine (8 and 23 weeks after completing iron supplementation), UI, TSH, T(4) and thyroid volume were remeasured. RESULTS: The prevalence of goiter at 30 weeks after oral iodine in Groups 1 and 2 was 12% and 64% respectively. Mean percent change in thyroid volume compared with baseline at 30 weeks in Groups 1 and 2 was -45.1% and -21.8% respectively (P<0.001 between groups). After iron supplementation in Group 2, there was a further decrease in mean thyroid volume from baseline in the anemic children (-34.8% and -38.4% at 50 and 65 weeks) and goiter prevalence fell to 31% and 20% at 50 and 65 weeks. CONCLUSION: Iron supplementation may improve the efficacy of oral iodized oil in goitrous children with iron-deficiency anemia.

Effect of Omeprazole on Oral Iron Replacement in Patients with Iron Deficiency Anemia

2004 ◽  
Vol 97 (9) ◽  
pp. 887-889 ◽  
Author(s):  
Vivek R. Sharma ◽  
Mark A. Brannon ◽  
Elizabeth A. Carloss
Keyword(s):  
Iron Deficiency ◽  
Iron Deficiency Anemia ◽  
Oral Iron ◽  
Deficiency Anemia ◽  
Iron Replacement

scholarly journals Hematologic Effects of Levothyroxine in Iron-Deficient Subclinical Hypothyroid Patients: A Randomized, Double-Blind, Controlled Study

2009 ◽  
Vol 94 (1) ◽  
pp. 151-156 ◽  
Author(s):  
Hakan Cinemre ◽  
Cemil Bilir ◽  
Feyzi Gokosmanoglu ◽  
Talat Bahcebasi
Keyword(s):  
Iron Deficiency ◽  
Iron Deficiency Anemia ◽  
Subclinical Hypothyroidism ◽  
Serum Iron ◽  
Oral Iron ◽  
Iron Therapy ◽  
Deficiency Anemia ◽  
Controlled Study ◽  
Iron Group ◽  
Iron Deficient

Abstract Context: In patients with coexisting iron-deficiency anemia and subclinical hypothyroidism, anemia does not adequately respond to oral iron therapy. Objective: We studied whether iron-deficiency anemia might indicate treatment of subclinical hypothyroidism. Design: Patients were assigned to a control or experimental group: 240 mg/d oral iron alone (iron group) or 240 mg/d oral iron plus 75 μg/d levothyroxine (iron/levothyroxine group). Levels of hemoglobin, hematocrit, red blood cell count, serum iron levels, ferritin, total iron-binding capacity, TSH, and free T4 were measured before and after treatment. Setting: The study was conducted at a university hospital outpatient clinic. Patients: Fifty-one patients with coexisting iron-deficiency anemia and subclinical hypothyroidism participated in the study. Intervention: Patients were treated as described above in either the iron group or the iron/levothyroxine group. Main Outcome Measure: A clinically satisfactory increase in hemoglobin was regarded as successful. Results: Mean hemoglobin levels increased by 0.4 g/dl in the iron group [95% confidence interval (CI) 0.2–0.7, P = 0.001], whereas it increased by a mean of 1.9 g/dl in the iron/levothyroxine group (95% CI 1.5–2.3, P &lt; 0.0001). The increase in serum iron was greater in the iron/levothyroxine group by a mean of 47.6 μg/dl (95% CI 34.5–60.6, P &lt; 0.0001). Increases in hemoglobin, red blood cells, hematocrit, and serum ferritin levels after treatment were statistically significantly greater in the iron/levothyroxine group (P &lt; 0.0001). Starting hemoglobin and increase in hemoglobin were negatively correlated in the iron/levothyroxine group (r = −0.531, P = 0.006). Conclusions: Subclinical hypothyroidism should be treated in iron-deficiency anemia patients when both conditions coexist. This would provide a desired therapeutic response to oral iron replacement and prevent ineffective iron therapy.

scholarly journals Feralgine™ a New Approach for Iron Deficiency Anemia in Celiac Patients

Nutrients ◽  
2019 ◽  
Vol 11 (4) ◽  
pp. 887 ◽  
Author(s):  
Laura Giancotti ◽  
Valentina Talarico ◽  
Giuseppe Antonio Mazza ◽  
Santina Marrazzo ◽  
Pietro Gangemi ◽  
...  
Keyword(s):  
Iron Deficiency ◽  
Iron Deficiency Anemia ◽  
Serum Iron ◽  
Iron Absorption ◽  
Duodenal Mucosa ◽  
Oral Iron ◽  
Deficiency Anemia ◽  
New Approach ◽  
Iron Treatment ◽  
High Absorption

Background: Celiac disease (CD) is an immunologically-mediated disorder characterized by duodenal mucosa villi atrophy. Iron absorption is usually reduced in celiac patients making every kind of oral iron treatment unhelpful because of malasorption. Feralgine™ is a new product that has been demonstrated to be more bioavailable. As such, the aim of our study was to evaluate the absorption of Feralgine™ in adult patients with CD. Methods: Twenty-six adults affected by Iron Deficiency Anemia (IDA), of which 14 were also affected by CD and 12 were not affected by CD, were enrolled. An oral iron absorption test (OIAT) was performed in each patient by administrating Feralgine™, and serum iron was evaluated at baseline (T0) and after 2 h (T1) from the oral iron ingestion. Results: The OIAT was well tolerated in all patients, and, surprisingly, an equivalent statistically significant improvement in serum iron occurred in the two groups of patients (IDA plus CD: T0 = 28.21 µg/dL vs. T1 = 94.14 µg/dL p = 0.004 and IDA without CD: T0 = 34.91 µg/dL vs. T1 = 118.83 µg/dL, p = 0.0003). Conclusions: These results demonstrated the high absorption of Feralgine™ in celiac patients, confirming our previous data obtained with Ferrous Bysglicinate in children with CD.

Oral iron absorption test in children with celiac disease and iron deficiency anemia: New insight for a forgotten test

2014 ◽  
Vol 46 ◽  
pp. e114
Author(s):  
Giuseppe Antonio Mazza ◽  
Giulia Paolella ◽  
Luisa Pedrelli ◽  
Elisabetta Battaglia ◽  
Laura Giancotti ◽  
...  
Keyword(s):  
Celiac Disease ◽  
Iron Deficiency ◽  
Iron Deficiency Anemia ◽  
Iron Absorption ◽  
Oral Iron ◽  
Deficiency Anemia ◽  
Absorption Test

Iron Deficiency Anemia: Adverse Effects on Infant Psychomotor Development

PEDIATRICS ◽  
1989 ◽  
Vol 84 (1) ◽  
pp. 7-17 ◽  
Author(s):  
Tomas Walter ◽  
Isidora De Andraca ◽  
Patricia Chadud ◽  
Carmen G. Perales
Keyword(s):  
Iron Deficiency ◽  
Iron Deficiency Anemia ◽  
Iron Status ◽  
Oral Iron ◽  
Iron Therapy ◽  
Psychomotor Development ◽  
Deficiency Anemia ◽  
Placebo Control ◽  
Double Blind ◽  
Iron Deficient

In a double-blind, placebo-control prospective cohort study of 196 infants from birth to 15 months of age, assessment was made at 12 months of age of the relationship between iron status and psychomotor development, the effect of a short-term (10-day) trial of oral iron vs placebo, and the effect of long-term (3 months) oral iron therapy. Development was assessed with the mental and psychomotor indices and the infant behavior record of the Bayley Scales of Infant Development in 39 anemic, 30 control, and 127 nonanemic iron-deficient children. Anemic infants had significantly lower Mental and Psychomotor Developmental Index scores than control infants or nonanemic iron-deficient infants (one-way analysis of variance, P &lt; .0001). Control infants and nonanemic iron-deficient infants performed comparably. No difference was noted between the effect of oral administration of iron or placebo after 10 days or after 3 months of iron therapy. Among anemic infants a hemoglobin concentration &lt; 10.5 g/dL and duration of anemia of &gt; 3 months were correlated with significantly lower motor and mental scores (P &lt; .05). Anemic infants failed specifically in language capabilities and body balance-coordination skills when compared with controls. These results, in a design in which intervening variables were closely controlled, suggest that when iron deficiency progrsses to anemia, but not before, adverse influences in the performance of developmental tests appear and persist for at least 3 months despite correction of anemia with iron therapy. If these impairments prove to be long standing, prevention of iron deficiency anemia in early infancy becomes the only way to avoid them.

scholarly journals ASSOCIATION OF POTENTIAL CELIAC DISEASE AND REFRACTORY IRON DEFICIENCY ANEMIA IN CHILDREN AND ADOLESCENTS

2018 ◽  
Vol 55 (1) ◽  
pp. 78-81 ◽  
Author(s):  
Mahdi SHAHRIARI ◽  
Naser HONAR ◽  
Ali YOUSEFI ◽  
Hazhir JAVAHERIZADEH
Keyword(s):  
Celiac Disease ◽  
Iron Deficiency ◽  
Iron Deficiency Anemia ◽  
Pediatric Care ◽  
Deficiency Anemia ◽  
Serologic Test ◽  
Care Clinic ◽  
Number Of Patients ◽  
Iron Deficient ◽  
Serologic Screening

ABSTRACT BACKGROUND: Celiac disease is an enteropathy caused by dietary gluten. The combination of serologic, genetic and histologic data has led to description of other categories of this disease. OBJECTIVE: There are a number of patients with iron deficiency anemia (IDA) that do not respond to iron treatment and may be repeated for many times, Therefore, we aimed to investigate celiac disease in this group. METHODS: In this cross sectional transverse prospective study from August 2011 to February 2013, in a Pediatric care clinic affiliated to Shiraz University of Medical Sciences, 184 children including 92 IDA patients who responded to treatment using iron supplement, 45 non-responding iron deficient patients, and 47 healthy individuals, with the maximum age of 18 years, with written consent from their parents, participated in serologic screening (with Anti-TTG antibody and anti-Endomysial antibody) for celiac disease. Patients with at least one positive serology test underwent multiple mucosal biopsy from bulb and duodenum. RESULTS: Among 184 participants, 19 (10.3%) subjects had positive serologic test for celiac disease, including 13 (28.9%) patients in the group with refractory IDA, 5 (5.4%) patients in the group with treated IDA, and 1 patient in the healthy group. The frequency of positive serologic test in the group with IDA resistant to treatment was prominently higher than the other two groups (P<0.001). Among the patients with positive serologic celiac test who underwent endoscopy and biopsy, no histologic evidence of celiac disease was seen. They were diagnosed as potential celiac disease. CONCLUSION: Frequency of potential celiac disease in patients with refractory IDA was higher than control the subjects. Therefore, we recommend serologic screening for early detection and minimizing the complications of celiac disease and repeated iron therapy for this group.

Serum Pro-Hepcidin Level in Helicobacter Pylori-Infected Iron Deficiency Anemia Patients.

Blood ◽  
2009 ◽  
Vol 114 (22) ◽  
pp. 5101-5101
Author(s):  
Mark Lee ◽  
Eun Young Song ◽  
Yeo Min Yun ◽  
So Young Yoon ◽  
Yo Han Cho ◽  
...  
Keyword(s):  
Helicobacter Pylori ◽  
Iron Deficiency ◽  
Iron Deficiency Anemia ◽  
Conflicts Of Interest ◽  
Oral Iron ◽  
Deficiency Anemia ◽  
Enzyme Linked Immunosorbent Assay ◽  
Hepcidin Level ◽  
H Pylori ◽  
Iron Replacement

Abstract Abstract 5101 Background Helicobacter pylori infection seems to subvert the human iron regulatory mechanism, and thus up-regulate hepcidin that results in unexplained iron deficiency anemia (IDA). We evaluated serum pro-hepcidin levels before and after H. pylori eradication in IDA patients to assess whether it plays a role in H. pylori-related IDA. Materials and Methods Subjects diagnosed as unexplained IDA underwent upper gastrointestinal endoscopy and colonoscopy to diagnose H. pylori infection and to exclude gastrointestinal bleeding. Blood sampling were done before H. pylori eradication and after a month. Serum pro-hepcidin level was measured by a commercialized enzyme-linked Immunosorbent assay kit. Results Initial serum pro-hepcidin levels were not different between 23 H. pylori-infected subjects (212.9 ± 88.2 ng/ml) and nine non-infected subjects (217.8 ± 56.2 ng/ml) (p=0.879). Serum pro-hepcidin level decreased after either dual oral iron replacement with H. pylori eradication (p=0.011) or H. pylori eradication without iron replacement (p=0.075). It also decreased after iron replacement in non-infected subjects (p=0.086). The reduction ratio of serum pro-hepcidin level after the treatment was not different between three groups (p=0.972). Conclusions Serum pro-hepcidin level decreases after either H. pylori eradication or oral iron administration with IDA improvement. Serum pro-hepcidin is related to the status of anemia rather than the presence of H. pylori itself. Disclosures No relevant conflicts of interest to declare.

Economic, Transfusion, and Efficacy Outcomes with the Addition of IV Iron Sucrose to Oral Iron Therapy in Pregnancy Associated Iron Deficiency Anemia

Blood ◽  
2016 ◽  
Vol 128 (22) ◽  
pp. 4737-4737
Author(s):  
Nilupa Gaspe Mudiyanselage ◽  
Tarek Elrafei ◽  
Beth Lewis ◽  
Mary King ◽  
Marianna Strakhan ◽  
...  
Keyword(s):  
Iron Deficiency ◽  
Pregnant Women ◽  
Iron Deficiency Anemia ◽  
Oral Iron ◽  
Iron Sucrose ◽  
Iron Therapy ◽  
Deficiency Anemia ◽  
Iron Group ◽  
Iv Iron ◽  
Iron Replacement

Abstract Background: Prior studies have indicated that transfusion is unusual (2%) in pregnant women with iron deficiency anemia. Nonetheless, compliance with oral iron replacement can be an issue and physicians may wish to use IV iron therapy in markedly anemic pregnant women. Objectives: to evaluate the effectiveness of adding intravenous iron sucrose concentrate (ISC) to pregnant patients already taking oral iron in terms of effect on hemoglobin, effect on ferritin levels, rates of transfusion, and cost. Methods: We analyzed all referrals from Obstetrics to Hematology clinic and Obstetrics consultation (Internal medicine) clinic from January 2014 to June 2016. Of the 176 pregnant patients, 98 were referred for anemia, including 81 patients with Hgb < 12 g/dl and ferritin < 20 ug/L. All had previously been given oral ferrous sulfate prescriptions. Patients with hemoglobinopathy were excluded. All 81 patients were advised to continue on the oral iron, and 40 were given IV iron sucrose (ISC group). Results: The average cumulative dose of iron sucrose was 700 mg, a mean of 5.575 doses (initiated in the third trimester in 38 of 40 patients). The lowest antepartum Hgb was 8.18 g/dl in the ISC group and 9.58 in the oral only group; there was an average Hgb increase of 2.17 vs 1.76 g/dl respectively (p=.107 NS and the 0.41 g/dl difference was considered to be of no clinical consequence). 89% in the ISC group vs 30% in the oral achieved a ferritin >20 (p=0.000015). No adverse events in the IV iron group were reported. There was 1 transfusion in the oral iron group attributable to iron deficiency (2.4%) vs none in the IV iron group (p = 0.107 NS). Two patients were transfused in the antenatal period before IV iron was started and 1 transfused because of post-partum hemorrhage. The total cost of the IV iron therapy would add an average of $1,500 per patient. Thus, and additional cost of $60,000 in IV iron would be required to prevent 1 transfusion [40:1]. Conclusions: ISC corrects ferritin in more patients than oral iron replacement, but did not significantly increase Hgb levels or have a meaningful impact on the transfusion rate. The additional cost and lack of clinically improved outcomes with IV iron argue against its use and in favor of strategies to ensure compliance with oral iron. Disclosures No relevant conflicts of interest to declare.

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