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Iron deficiency due to PPI's???

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  • Iron deficiency due to PPI's???

    My blood levels are very poor and my PCP is now sending me to a hematologist next week for a consult. Since my initial bloodwork was done in July, I had a celiac blood panel come back negative and a GI bleed was ruled out by a recent colonoscopy and capsule endoscopy (pillcam - very fascinating test!). My B12 levels are very good - one of the few levels that are normal.

    I don't understand this at all. If it is not a GI bleed he said it might be malabsorption problem. Can you have malabsorption due to PPI's if your B12 is normal? Has anyone here developed iron deficiency anemia as a result of taking PPI's?

  • #2
    Hi Sue I have been on double dose of ppis for about 4 months. I asked my pcp to check my vitamin. level. my b12 and vitamin d folic acid was good but my b1 was was low. No one can tell me why b1 is low.( I dont drink)
    I was thinking it was from the ppis.

    Take care Ron


    • #3

      Originally posted by sue1420;56015fascinating test!). My B12 levels are very good - one of the few levels that are normal. [quote

      I don't understand this at all. If it is not a GI bleed he said it might be malabsorption problem. Can you have malabsorption due to PPI's if your B12 is normal? Has anyone here developed iron deficiency anemia as a result of taking PPI's?
      Hi Sue Yes you can definately have malapsorption if B 12 levels are normal. . Iron deficiency anemia as a result of taking PPI's would be rare though ...possible , but not most probable , something to bring up with your doctor at least . You can get malapsorption from a few medications . Actually there are a lot of causes of malapsorption.

      AS for the anemia .... Have you had urine tests ? That would be important . Have you only had one endoscopy and one colonoscopy since you developed this problem ? If so , you might want to have those tests repeated by a different GI just to make sure nothing was missed .

      Have you been checked for uterine fibroids ... your liver is Ok ? Is it possible you are just not getting enough iron in your diet? If you don't have diahreaha, malapsorption is less likely but certainly still possible. Well best of luck to you Sue . Take Care


      • #4
        Thanks Tricia for your suggestions. I do take a few other meds for my Blood pressure and asthma but there is nothing listed for them regarding malabsorption. I just re-read the info on them. Amazingly I have not had a urine test & I wondered about that logic. I had an upper endoscopy and BRAVO test in September 2007 and a follow-up EGD in March 2008. Both showed an old ulcer (that I never knew I had) and gastric polyps. The colonoscopy was just done on October 16 and the pillcam was done on October 28. My GI doctor said it was not necessary to do another upper endoscopy since I just had one in March. The blood work that showed the anemia was done on July 23. I do have fibroids (4) but I am post-menopausal and have not had any spotting. Not sure if my liver is good or bad - I think it is okay but haven't any recent bloodwork. I do have a hemangioma on my liver but when I reminded my GI about it she assured me that was not casuing the anemia.

        I've been searching the web trying to get a handle on this and get so confused with all I have been reading. I guess I need to just wait and see the hematologist instead of second guessing but it is very worrisome of course. If we only didn't have to wait so long for test results and calls back from our doctors and appointments for diagnostic tests..... I had to wait 6 weeks for the colonscopy!!! Ugh! so frustrating


        • #5

          Hi Sue Good luck to you , and hopefully the hematologist can help you figure it out . I know these things can be stressful , especially the time it takes to get answers .. Don't be afraid to get pushy if need be , we have to look out for number one .

          I noticed you've had no fecal fat test either for malapsorption . Your mail in occult test was ok ? Are you on trial iron supplementation ?

          I think a Urinalysis is important to check for hematuria . Also since the gut and kidneys share the same transporter you can sometimes see an excess amount of malabsorbed substances in the urine . A Urinalysis can tell us a lot about our health in general.

          Remember in PM women the number one cause of this anemia is bleeding from the GI tract. Since you have a history of ulcers and poylps, etc , i don't see why your GI doesn't think another scope would be important . Especially in someone with an ulcer history . Also keep in mind that these tests don't have a 100 percent accuracy rate by any means so it never hurts to double check , especially if at a dead end. You don't have rheumatoid arthritis ? That can do it . Actually i've read any inflamatory process can do it . Has your vitamin C been checked ?

          Well best of luck with your appointment this week. I hope everything turns out perfect for you . Take Care


          • #6
            Thank you Tricia for your suggestions and encouragement! I know only full well that you need to question, question, question and get copies of all your test results and change doctors if necessary - all of which which I have done - BUT it is so tiring sometimes and I would hate to be labeled as a difficlut patient but you do have to look out for number one. Trouble is it is tough being your own doctor when you never went to medical school!

            (Ironically I need to call my GI doc and discuss a comment on the letter she sent me regarding the colonoscopy - although a polyp was found she recommends that a follow-up c'scope be done in 7 - 10 years. I disagree with that logic totally. My husband had a polyp and he was told to come back in 3 years and when that c'scope showed no polyps he was told to return in 5 years. not that I want to repeat that test to soon but I do not feel confident waiting 7 years for a follow-up.)

            To answer your questions - my occult stool tests were negative. Can't say that I've ever seen a Vitamin C level on a blood test result. I don't have RA.

            I did kind of think that a urinalysis would be an important test so I will ask the hematologist her opinion on the subject.

            Thank you again for you helpfulness - your answers are always so informative!

            Take Care!


            • #7

              Hi Sue How did you make out with the hemotologist ?


              • #8
                Sue, my gastroenterologist said that because I had a polyp, I would need repeat colonoscopies every 2-3 years for 10 years. If I was clear for 10 years I could go to 5 years. He said 5 years is now the standard for everyone if they don't have a family history. If they do, or if they have had a polyp, 3 years is the standard. If you have a polyp and a family history, 2 years is the new standard. I would find a new doctor. This is widely known and I would question any doctor so out of touch with current medicine. Even my family practice guy knew this.


                • #9
                  because I had a polyp, I would need repeat colonoscopies every 2-3 years for 10 years.
                  I'd like to second this post -- same thing my doctor told me about finding polyps during a colonoscopies. You repeat every 2-3 years. (So far I haven't fallen into this category.)


                  • #10
                    thanks for following up on me. I apologize for not posting back. It has been a little hectic since my visit with the hematologist. I saw her on Thursday, November 13 and besides taking lots of blood, a urinalyis at my request, asking lots of questions, giving me another home stool test to do (FYI: not the 3 little cards but a little bottle with liquid in it and you did n't have to watch what you ate prior to doing the sample - called Clearview OBT), I left with very few answers and a follow-up visit for Nov. 21.

                    Until Saturday morning when she called me at home to tell me that she got some of the bloodwork results and my ferritin and iron were very low and she wanted me on oral iron supplements right away. She called in a prescription for me and what a surprise I got when I went to pick it up. It was not covered by my (very good) insurance because it is considered an OTC vitamin. The doctor told me she was calling in a script for me beacause she wanted me to try this particular iron with vitamin c because it had less GI side effects which for me which be helpful. A 30 day supply cost $115.99.

                    I paid for it but immediately called the insurance company on Monday and am now busy filing an appeal to have it covered.

                    The doctor also told me to come back in 2 weeks instead of last week so she can do another blood test to see if the iron is helping.

                    then as if i didn't have enought to deal with, last week I got an upper respiratory bug and had an asthma flare so now I'm on prednisone and some other asthma med and I feel like a zombie.

                    Hopefully I will know more when I see her December 3.

                    thanks so very much for asking. you'll never know how nice it was to see your updated message in my email.


                    • #11
                      Hello Bugrat and Thistle,

                      thanks for the positive reinforcement about the repeat colonscopy. I did and do feel that I need to have one sooner than 7- 10 years. Your comments make me realize that I'm not off-base.

                      I will discuss this with my GP when I see him in December and get his feedback. I might have to change GI's. I wasn't all that satisfied with her and her office over this and some events. For instance she never called me to tell me that my celiac panel was negative for gluten and that I needed to have a c'scope. I had to call her and then never heard back from her for 3 days. then I had to wait 6 weeks for the first available c'scope appointment which was so frustrating. I'm sorry to whine but I have been waiting since July 23 to find out what is wrong with my iron deficiency levels and it is so hard to deal with.



                      • #12

                        Hi Sue Thank you for updating , i was wondering about you . Sorry you have yet another problem to deal with , that's all you need . Maybe 2009 will be better It sounds to me you should win with your insurance . Those are some expensive vitamins . I hope they work .

                        It's very frustrating waiting for tests and results . If the hematologist doesn't do something quick i'd go see another GI and get a repeat colonoscopy and endoscopy . This can drag on for many months/ i've seen even years ... if you let them. . Wishing you the best Sue and hoping this gets straightened out soon and everything turns out great for you


                        • #13
                          I will discuss this with my GP when I see him in December and get his feedback.
                          Remember that many insurance companies give bonuses to doctors for not ordering tests (which cause them to spend money on you). If your doctors are playing this game, this might explain why you aren't being taken care of appropriately. I had this happen with a doctor once, and my ultimate solution was to get another one.