Association of Long-Term Proton Pump Inhibitor Use With Nutrient Deficiencies: A Retrospective Cross-Sectional Study
Abstract
Background Proton pump inhibitors (PPIs) are generally employed to treat acid-related disorders. However, chronic acid blockade can reduce the absorption of essential micronutrients, such as vitamin B12, magnesium, calcium, and iron, potentially contributing to clinically significant deficiencies as defined by standard laboratory reference ranges. Methods A retrospective observational study was conducted using electronic medical records collected between July and December 2025. The study included adults (18 years and older) who had been taking PPIs continuously for six months or more. Nutrient deficiencies were defined according to institutional laboratory reference ranges, with the following cut-off values: vitamin B12 <200 pg/mL, magnesium <1.7 mg/dL, calcium <8.6 mg/dL, and ferritin <30 ng/mL. Both centers used identical reference ranges and standardized laboratory protocols, and all results were cross-checked to minimize inter-laboratory variability; any inconsistent or repeated values were excluded from analysis. The associations between PPI type/duration and deficiency status were analyzed using the Fisher-Freeman-Halton exact test, the chi-square test, and the Kruskal-Wallis test (p<0.05). Findings The sample consisted of 255 participants: 139 (54.5%) female patients and 116 (45.5%) male patients. The patients were on omeprazole (n=101; 39.6%), pantoprazole (n=64; 25.1%), esomeprazole (n=61; 23.9%), and lansoprazole (n=29; 11.4%). The prevalence of vitamin B12…
How strong is the evidence?
Evidence Hub reads this as a cross-sectional, done in people. Its evidence level is 4 of 5 (Low · observational). Observational designs can show an association but not prove cause. Reported size: 255 participants or records.
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