Proton pump inhibitors (PPIs) reduce the production of acid by blocking the enzyme in the wall of the stomach that produces it. They are commonly used to treat short term problems such as heartburn or ulcers. Proton pump inhibitors lower the concentration of vitamin C in gastric juice and work to reduce the absorption of non-haem iron.
Iron in food can be in the form of either haem-iron or non-haem iron. Haem-iron does not require any additional metabolism and can be absorbed through the haem transporter in the gut, however this process is not as efficient for non-haem iron. In order for non-haem iron to be absorbed it must be converted from its oxidised state to its reduced state. This conversion is facilitated by the acidity of the stomach.
PPIs make the stomach more alkaline, which then keeps non-haem iron in its oxidised state, reducing the rate of iron absorption.
There have been a number of previous studies looking at the effect of PPIs in patients with haemochromatosis. The two most recent of these have reported a reduction in the number of venesections that patients who are using PPIs require to stay in maintenance. However, the recently study by Annick Vanclooster et al. published in the American Gastroenterology Association Journal is the first time a double blind randomized trial has been used to test this theory.
The use of PPIs is a subject for debate. The long term implications of using the medication in this way are unknown and some possible risks have been identified. As well as Iron, PPIs can reduce the absorption of essential nutrients such as vitamin B12. For this and other reasons some think they may cause health problems if used for extended periods. Many believe that as venesection is a drug free and safe treatment using PPIs is an unnecessary risk. However PPIs could be helpful as an alternative way of maintaining healthy iron levels for those patients who struggle with, or are unable to have venesection.
The full study is available at http://www.gastrojournal.org/article/S0016-5085(17)35740-2/pdf
If you have any questions about the use of proton pump inhibitors please consult your doctor.