Dado David N, Loesch Erin B, Jaganathan Sudha P
Department of Internal Medicine, US Air Force Medical Corps, Wright Patterson Air Force Base, Dayton, Ohio.
Department of Internal Medicine, Boonshoft School of Medicine, Wright State University, Dayton, Ohio.
Curr Ther Res Clin Exp. 2017 Jan 21;84:1-3. doi: 10.1016/j.curtheres.2017.01.003. eCollection 2017.
The use of proton pump inhibitors (PPIs) in the treatment of gastrointestinal diseases has evolved over recent years. Initially intended for short-term use, PPIs are increasingly being used, often inappropriately, as long-term maintenance medications. The mechanism of action of PPIs is suppression of gastric basal and stimulated acid secretion by inhibiting the parietal cell H/K ATP pump with a resultant increase in gastric pH and hypo- or achlorhydria. Although short-term use is related to few adverse effects, long-term use is associated with numerous complications. We present the case of a 58-year-old man with severe iron deficiency anemia due to malabsorption suspected to be caused by long-term PPI use. An extensive medical work up failed to reveal any definitive source of bleeding. An iron malabsorption test confirmed that iron was not being absorbed from the gastrointestinal tract. The Naranjo Adverse Drug Reaction Probability Scale and the Horn and Hansten Drug Interaction Probability Scale are suggestive of an association between long-term PPI use and the observed iron deficiency anemia. However, the patient's death and lack of an autopsy prevented confirmatory follow-up data from being obtained to connect long-term PPI use as the culprit. Although there are currently no recommendations regarding screening for iron deficiency and/or anemia in patients on long-term PPI therapy, physicians should be aware of this potential side effect and consider monitoring in high-risk patients.
近年来，质子泵抑制剂（PPIs）在胃肠道疾病治疗中的应用不断演变。PPIs最初旨在短期使用，但现在越来越多地被用作长期维持药物，且常常使用不当。PPIs的作用机制是通过抑制壁细胞H/K ATP酶来抑制胃基础胃酸分泌和刺激胃酸分泌，从而导致胃pH值升高以及胃酸过少或无酸。虽然短期使用PPIs的不良反应较少，但长期使用会引发众多并发症。我们报告了一例58岁男性患者，因怀疑长期使用PPIs导致吸收不良而患有严重缺铁性贫血。全面的医学检查未能发现任何明确的出血源。铁吸收不良试验证实铁无法从胃肠道吸收。Naranjo药物不良反应概率量表和Horn与Hansten药物相互作用概率量表提示长期使用PPIs与观察到的缺铁性贫血之间存在关联。然而，患者的死亡以及缺乏尸检使得无法获得确证性的随访数据来确定长期使用PPIs为病因。尽管目前对于长期接受PPI治疗的患者筛查缺铁和/或贫血尚无相关建议，但医生应意识到这种潜在的副作用，并考虑对高危患者进行监测。
