# Effects of Long-Term Proton Pump Inhibitor Use on Serum Electrolytes and Vitamin Levels: A Quasi-experimental Study in Pakistan

## TL;DR

This study finds that long-term use of proton pump inhibitors in Pakistan leads to lower levels of magnesium, calcium, and vitamin B12 compared to other acid-suppressive therapies.

## Contribution

The study provides new evidence on the impact of PPIs on micronutrient levels in a South Asian population.

## Key findings

- PPI users had significantly lower magnesium, calcium, and vitamin B12 levels after 12 months.
- Other electrolytes and minerals showed no significant differences between the groups.
- Long-term PPI use is linked to potential nutritional deficiencies in South Asian patients.

## Abstract

Objective

The study aims to investigate the effects of long-term proton pump inhibitor (PPI) use on various micronutrients and electrolytes as compared to other acid-suppressive therapies in the South Asian population.

Study design and setting

This quasi-experimental study was conducted at the Department of Family Medicine in a a tertiary care setup in Rawalpindi, Pakistan from January 2022 to March 2023.

Materials and methods

Forty-nine patients with known gastric acid secretion-related disorders were randomized in two groups. The PPI group was treated with oral omeprazole, while the non-PPI group were given sucralfate and famotidine. Patients were followed up for a period of 12 months and levels of sodium, potassium, calcium, magnesium, phosphate, iron, vitamin B12, folate and vitamin D were checked using blood samples at baseline, three-, six-, and 12-month duration.

Results

The results showed that patients in the PPI group had significantly lower levels of magnesium (1.46 ± 0.15 mEq/L vs. 1.70 ± 0.14 mEq/L, p<0.01), calcium (8.96 ± 0.42 mg/dL vs. 9.50 ± 0.48 mg/dL respectively, p<0.01), and vitamin B12 (329.5 ± 134.7 pg/mL vs. 462.30 ± 193.7 pg/mL, p=0.009) as compared to non-PPI group at 12-month duration. Levels of other electrolytes and minerals did not show significant differences amongst both groups.

Conclusion

The study indicates that long-term PPI use is associated with lower levels of magnesium, calcium and vitamin B12 levels. Therefore, healthcare providers should consider monitoring these micronutrient levels in patients on long-term PPI therapy to prevent potential nutritional deficiencies.