Proton Pump Inhibitors Suppress Absorption of Dietary Non-Haem Iron in Hereditary Haemochromatosis

Gut. 2007 Sep;56(9):1291-5. doi: 10.1136/gut.2006.108613. Epub 2007 Mar 7.

Abstract

Background and aims: During the long-term treatment of patients with hereditary haemochromatosis (HH) the authors observed that proton pump inhibitors (PPI) reduced the requirement for maintenance phlebotomy. Gastric acid plays a crucial role in non-haem iron absorption and the authors performed a case review and intervention study to investigate if PPI-induced suppression of gastric acid would reduce dietary iron absorption in C282Y homozygous patients.

Methods: Phlebotomy requirements to keep serum ferritin approximately 50 microg/l before (mean 6.1 (SE 0.6) years) and during (3.8 (0.9) years) administration of a PPI were evaluated in seven patients and a post-prandial study was performed to determine whether PPIs reduce absorption of non-haem iron (14.5 mg) from a test meal in a further 14 phlebotomised patients with normal iron stores.

Results: There was a significant reduction (p<0.001) in the volume of blood removed annually before (2.5 (0.25) l) and while taking (0.5 (0.25) l) a PPI. Administration of a PPI for 7d suppressed absorption of non-haem iron from the meal as shown by a significant reduction (all p<0.01) in: area under the serum curve (2145 (374) versus 1059 (219)), % recovery of administered iron at peak serum iron (20.5 (3.2) versus 11.0 (2.0)%) and peak serum iron (13.6 (2.4) vs 6.1 (1.2) micromol/l) (all values are before vs during PPI).

Conclusions: Administration of a PPI to patients with HH can inhibit the absorption of non-haem iron from a test meal and the habitual diet.

MeSH terms

  • 2-Pyridinylmethylsulfinylbenzimidazoles / therapeutic use
  • Enzyme Inhibitors / therapeutic use*
  • Ferritins / blood
  • Gastric Acid / metabolism
  • Hemochromatosis / drug therapy
  • Hemochromatosis / genetics*
  • Hemochromatosis / metabolism
  • Humans
  • Intestinal Absorption / drug effects
  • Iron, Dietary / blood
  • Iron, Dietary / pharmacokinetics*
  • Lansoprazole
  • Middle Aged
  • Omeprazole / therapeutic use
  • Phlebotomy
  • Postprandial Period
  • Proton Pump Inhibitors*

Substances

  • 2-Pyridinylmethylsulfinylbenzimidazoles
  • Enzyme Inhibitors
  • Iron, Dietary
  • Proton Pump Inhibitors
  • Lansoprazole
  • Ferritins
  • Omeprazole