What is the Latest on GERD and the need for B12?
The Question
What are the considerations related to vitamin B12 status in individuals with gastroesophageal reflux disease (GERD)?
The Recommendation
Although individuals with GERD who take proton pump inhibitor (PPI) medications may have lower vitamin B12 levels than individuals not taking PPIs, evidence is not strong enough to warrant routine advice to increase vitamin B12 intake. Similarly, routine monitoring of vitamin B12 levels is not warranted in asymptomatic individuals without other risk factors for vitamin B12 deficiency.
Evidence Summary
A 2022 systematic review of seven observational studies (one cross-sectional, one case-control, five prospective cohort) concluded that chronic PPI use can lower vitamin B12 levels. Further high quality research is required to elucidate this effect.
Clinical guidelines for GERD management recommend that individuals who take PPIs should not be routinely advised to increase their vitamin B12 intake or routinely monitored for vitamin B12 deficiency.
Grade of Evidence C
Remarks
PPIs inhibit gastric acid production, which is necessary for vitamin B12 absorption in humans. Gastric acid converts pepsinogen into pepsin, which allows vitamin B12 to be released from proteins in food.
There is no “gold standard” test for vitamin B12 deficiency, which makes research on the topic heterogeneous.
To see the full practice question, including the Evidence Summary, Evidence Statements, Comments, Rationale and References, click here.
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July 2023 ·
Volume 13
(7)