Absorption of non-heme iron during gastric acid suppression in patients with hereditary hemochromatosis and healthy controls

• Published in: American journal of physiology: Gastrointestinal and liver physiology 2021-05
• Main Authors: Moris, Wenke, Verhaegh, Pauline L M, Verbeek, Jef, Swinkels, Dorine W, Laarakkers, Coby M, Masclee, Adrian A M, Koek, Ger H, van Deursen, Cees Th B M
• Format: Article
• Language: English
• ISSN: 1522-1547
• DOI: 10.1152/ajpgi.00371.2020

Phlebotomies are performed in hereditary hemochromatosis (HH) to maintain normal iron concentrations. Proton pump inhibitors (PPIs) can reduce the number of phlebotomies in HH patients. However, in patients without HH, the iron concentrations do not appear to be compromised when using PPIs. Therefore, we aim to explain the differences in iron absorption between patients with and without HH. In ten p.C282Y homozygous HH patients with normalized iron stores and ten healthy control subjects (HCs), the iron parameters and hepcidin concentrations were determined before ingestion of a pharmacological dose of 50 mg iron (Fe3+) polymaltose, and hourly for four hours afterwards. This was repeated after seven days' treatment with pantoprazole 40 mg once daily. Serum iron concentrations and transferrin saturation percentages dropped significantly during PPI use in the HH patients, while no changes were observed in the HCs. Hepcidin concentrations were lower in the HH patients compared with the HCs both before and during PPI use. In both groups hepcidin levels did not significantly decrease during the treatment. Seven day PPI use significantly reduces iron absorption in HH patients but not in HCs. Changes in hepcidin concentrations could not explain these different PPI effects on iron absorption probably due to a small sample size.