Overcoming side effects of GORD treatment
Treating reflux, peptic ulcers and other upper gastrointestinal disorders
Gastro-oesophageal reflux disease, or GORD in short, is prevalent worldwide, as is peptic ulcers.
A class of medication known as proton pump inhibitors (PPIs) remain the choice of treatment for GORD, peptic ulcers and other upper gastrointestinal disorders and has proven to be efficient2, 3.
The problem with PPIs
The PPIs are however associated with an increased risk for vitamin and mineral deficiencies, impacting vitamin B12, calcium, vitamin C, iron and magnesium metabolism4.
PPIs may lead to vitamin B12 malabsorption, and cause symptoms such as fatigue due to anaemia1, 4, 6.
Magnesium transport and absorption can also be impacted by PPIs and could lead to symptoms such as tremors and irregular heartbeat1, 4, 5, 7.
PPI-GAP helps patients maintain the essential nutrients, vitamin B12 and magnesium, that may be depleted as a result of the treatment of reflux and gastric ulcers1.
Overcoming side effects of GORD treatment
Gastro-oesophageal reflux disease is prevalent worldwide and disease burden may be increasing1
Deficiencies associated with PPI use
Vitamin B12 and magnesium deficiency associated with PPI use
- Gastric acidity is required for vitamin B12 absorption3
- Acid suppression by PPIs may lead to vitamin B12 malabsorption3,4
- Vitamin B12 status has been shown tomdecline during prolonged PPI use in older adults5
- Most clinical cases of vitamin B12 deficiencies are undetected, while more profound cases may present with neuropsychiatric and haematologic findings (e.g. macrocytic anaemia)3
- PPIs can inhibit active magnesium transport and absorption in the intestine6, 7
- In 2011, the FDA released a warning that PPIs may cause hypomagnesaemia if taken for longer than a year3
- All PPIs are associated with hypomagnesaemia, with esomeprazole
having the lowest risk and pantoprazole the highest7
- Risk is higher in males and the elderly population7
- Symptoms of overt hypomagnesaemia and associated hypocalcaemia and
hypokalaemia include: tetany, tremors, seizures and arrythmias7
PPI-GAP helps patients maintain the essential nutrients that may be depleted as a result of the treatment of reflux and gastric ulcers8
Dosage & directions for use
Please note: This is an educational information leaflet only and should not be used for diagnosis. For more information on reflux and ulcers, consult your healthcare professional.
- PPI-GAP approved package insert 2017, Adcock
- Denis M, Proton Pump Inhibitors in the Management of Patients with Acid-Peptic Disorders: A Managed Care Perspective, Drug Class Review, Vol. 30 No. 5, May 2005
- M Michael Wolfe, MD, Proton pump inhibitors: Overview of use and adverse effects in the treatment of acid related disorders, Up to Date Literature Review, Jul 2018
- Joel J. Heidelbaugh, Proton pump inhibitors and risk of vitamin and mineral deficiency: evidence and clinical implications, Ther Adv Drug Saf. 2013 Jun; 4(3): 125–133
- James Wei Tatt Toh, Hypomagnesaemia associated with long-term use of proton pump inhibitors, Gastroenterol Rep (Oxf). 2015 Aug; 3(3): 243–253
- Atli Arnarson, PhD, 7 Signs and Symptoms of Magnesium Deficiency, Health Line Newsletter, Dec 15, 2017
- Helen West, RD, 9 Signs and Symptoms of Vitamin B12 Deficiency, Health Line Newsletter, Oct 7, 2017
1. El-Serag HB, Sweet S, Winchester CC, et al. Update on the epidemiology of gastro-oesophageal reflux disease: a systematic review. Gut 2014;63(6): 871-880.
2. Heidelbaugh JJ, Kim AH, Chang R, et al. Overutilization of proton-pump inhibitors: what the clinician needs to know. Ther Adv Gastroenterol 2012;5(4) 219–232.
3. Heidelbaugh JJ. Proton pump inhibitors and risk of vitamin and mineral deficiency: evidence and clinical implications. Ther Adv Drug Saf 2013;4(3):125-133.
4. Lam JR, Scheider JL, Zhao W, et al. Proton pump inhibitor and histamine 2 receptor antagonist use and vitamin B12 deficiency. JAMA 2013;310(22):2435-2442.
5. Dharmarajan TS, Kanagala MR, Murakonda P, et al. Do acid-lowering agents affect vitamin B12 status in older adults? J Am Med Dir Assoc 2008;9:162-167.
6. Cundy T, Dissanayake A. Severe hypomagnesaemia in long-term users of proton-pump inhibitors. Clin Endocrinol 2008;69:338-341.
7. Luk CP, Parsons R, Lee YP, et al. Proton pump inhibitor-associated hypomagnesemia: what do FDA data tell us? Ann Pharmacother 2013;47:773-780.
8. PPI-GAP Capsule, approved package insert, 2017.
9. Ross CA, Taylor CL, Yaktine AL, et al (eds). Dietary Reference Intakes
(DRIs): Dietary reference intakes for calcium and vitamin D. Institute of Medicine, National Academy of Sciences, 2011. [cited 2017 Mar 17]; Available from: https://www.nap.edu/13050.
10. De Baaij JHF, Hoederop JGJ, Bindels RJM. Magnesium in man: implications for health and disease. Physiol Rev 2015;95:1-46.