Effect of long-term proton pump inhibitor therapy on complete blood count parameters and selected trace elements: A pilot study

Abstract

INTRODUCTION Proton pump inhibitors (PPIs) are widely prescribed for several gastrointestinal conditions, often as long-term therapy. The effects of long-term PPI use have not been fully elucidated. OBJECTIVES We aimed to determine the association between long-term PPI use and complete blood count parameters, particularly red blood cell (RBC) count, white blood cell (WBC) count, and hemoglo- bin concentrations, as well as serum levels of selected micronutrients such as selenium (Se), iron (Fe), copper (Cu), and zinc (Zn). PATIENTs AND METHODS We enrolled 37 patients on long-term PPI therapy (mean [SD] age, 57.1 [15.4] years) and 30 healthy controls (mean [SD] age, 39.3 [11.8] years). In each group, complete blood count, and serum Fe levels were performed, and serum Cu, Zn, and Se levels were measured using atomic absorption spectrometry. RESULTS Red blood cell and WBC counts were lower in the PPI group compared with controls (mean [SD], 4.24 [0.55] ×106/μl vs 4.7 [0.4] ×106/μl; P <0.001 and 6.13 [1.44] ×103/μl vs 7.3 [1.28] ×103/μl; P <0.001, respectively). Hemoglobin and serum Fe concentrations were also lower in the PPI group (mean [SD], 12.5 [1.8] g/dl vs 14.3 [0.8] g/dl; P <0.001 and 16.3 [5.4] μmol/l vs 23.4 [2.7] μmol/l; P <0.001, respectively). Serum Zn and Cu concentrations were higher in PPI users than in controls. CONCLUSIONS Long-term PPI therapy may reduce RBC and WBC counts as well as hemoglobin levels, leading to iron deficiency. It may also affect concentrations of some micronutrients, although the underly- ing mechanism of this association is not fully clear.