Impact of Long-Term PPI Therapy on Vitamin C Levels: Emerging Concerns

Abstract

PPIs are the most popular medications used in treatment of gastric diseases based on acids, and they turn out to be the strongest agents to suppress the acids. But extended use has been associated with hypochlorhydria and micronutrient deficiency Vitamin C being one. The efficacy of altered gastric acidity on the absorption of ascorbic acid and increasing its oxidation and subsequent reduced stomach and plasma levels of Vitamin C is studied in this narrative review, which is based on available clinical trials, case reports and mechanistic studies in the past 2 decades. Clinically, it cause dysfunctioning of collagen synthesis, immune deficiency, oxidative stress and in severe condition, scurvy. The vulnerable groups affected are the elderly, the malnourished, the post bariatric surgical and the Helicobacter pylori infected. Diet can help returning levels of the Vitamin C to normal, but close monitoring and actual nutritional planning are inevitable. This review gives relevance to increased clinical awareness, the individualization of supplementation strategy, and further research to reach some established regulations as to the prevention of nutrient deficiencies in long-term PPI users.

Keywords: Proton pump inhibitors; Vitamin C deficiency; Hypochlorhydria; ascorbic acid; acid suppressive therapy