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Gastric acid facilitates iron absorption. To determine if acid inhibition increases the risk for iron deficiency, investigators performed a nested case-control study of patients enrolled in the Kaiser Permanente health system of Northern California. They compared prior exposure to proton-pump inhibitors (PPIs) or histamine-2 receptor antagonists (H2RAs) — defined as having received at least a 2-year supply — between 77,046 patients who received a new diagnosis of iron deficiency between 1999 and 2013 (cases) and 389,314 matched controls. Results were as follows:
PPI exposure rates were 3.0% in cases and 0.9% in controls.
H2RA exposure rates were 1.4% in cases and 0.6% in controls.
Each exposure was associated with a statistically significant i…