Original article
Pancreas, biliary tract, and liver
Proton Pump Inhibitors Reduce the Frequency of Phlebotomy in Patients With Hereditary Hemochromatosis

https://doi.org/10.1016/j.cgh.2015.06.043Get rights and content

Background & Aims

Patients with hereditary hemochromatosis (HH) need frequent phlebotomies to reduce iron overload. Proton pump inhibitors (PPIs) were reported to reduce the need for phlebotomies in patients homozygous for the C282Y mutation in HFE. We investigated the effects of PPI treatment on numbers of phlebotomies in these patients.

Methods

We conducted a retrospective study of patients with HH homozygous for the C282Y mutation by using the database and medical records from Atrium Medical Centrum Parkstad in Brunssum, The Netherlands. In a paired group analysis of 12 patients, we compared mean serum levels of ferritin and number of phlebotomies needed each year during the periods of 3 years before and 3 years after the start of PPI therapy. We compared these results with those from a group who received PPIs for at least 2 years (n = 9) and a group who never received PPIs (n = 36).

Results

We found a significant reduction in median number of phlebotomies after patients began taking PPIs vs before (0.50 vs 3.17, P < .002). Patients who received PPIs for at least 2 years needed significantly fewer phlebotomies than patients in the paired group before they started taking PPIs (1.25 vs 3.17, P < .001). The number of phlebotomies in the group who never received PPIs was significantly higher than in the paired group after they started taking PPIs (3.0 vs 0.5, P < .001).

Conclusions

On the basis of a retrospective analysis, in patients with HH homozygous for the C282Y mutation in HFE, treatment with PPIs for 2 or more years significantly reduced the number of phlebotomies required to maintain serum levels of ferritin below 100 μg/L.

Section snippets

Study Design

We conducted a retrospective cohort study. All patients with HH were reviewed by using the electronic database and medical records at Atrium Medical Centrum Parkstad in Brunssum, a secondary medical center located in the south of Limburg, The Netherlands. Only patients with C282Y homozygosity, which was determined by genetic testing, were included. In a paired group, patients were included when data were available for at least 2 years before and 2 years after the start of PPI treatment. In the

Results

In the paired design, the median length of the recording period before and after the start of PPIs was 3.0 years (interquartile range [IQR], 3.0–3.0). Median SF levels did not differ significantly between the 2 periods (Table 2). In the period before start of PPIs, a total median of 3.16 phlebotomies (IQR, 2.08–3.66) was performed yearly, compared with a median of 0.50 phlebotomies (IQR, 0.00–0.66) per year in the period after start of PPIs. These results differed significantly (P = .002) (

Discussion

Longtime PPI treatment significantly reduces the phlebotomy frequency to maintain the SF level below 100 μg/L in HH patients with C282Y homozygosity, in agreement with the results of the study published by Hutchinson et al.10

These promising results open the way for an alternative add-on medical therapy for patients who need phlebotomies frequently. Administration of PPIs leads to fewer phlebotomies and thus fewer side effects compared with other interventions. Socioeconomic aspects are a

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Conflicts of interest The authors disclose no conflicts.

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