Proton pump inhibitors suppress absorption of dietary non-haem iron in hereditary haemochromatosis.
OBJECTIVE
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.
Hutchinson
Carol
C
The Iron Metabolism Interdisciplinary Research Group, King's College London, London, UK.
Geissler
Catherine A
CA
Powell
Jonathan J
JJ
Bomford
Adrian
A
D053799:2-Pyridinylmethylsulfinylbenzimidazoles / Q000627:therapeutic use; D004791:Enzyme Inhibitors / Q000627:therapeutic use*; D005293:Ferritins / Q000097:blood; D005744:Gastric Acid / Q000378:metabolism; D006432:Hemochromatosis / Q000188:drug therapy / Q000235:genetics* / Q000378:metabolism; D006801:Humans; D007408:Intestinal Absorption / Q000187:drug effects; D019266:Iron, Dietary / Q000097:blood / Q000493:pharmacokinetics*; D064747:Lansoprazole; D008875:Middle Aged; D009853:Omeprazole / Q000627:therapeutic use; D018962:Phlebotomy; D019518:Postprandial Period; D054328:Proton Pump Inhibitors
D053799:2-Pyridinylmethylsulfinylbenzimidazoles; D004791:Enzyme Inhibitors; D019266:Iron, Dietary; D054328:Proton Pump Inhibitors; D064747:Lansoprazole; D005293:Ferritins; D009853:Omeprazole