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The association between the use of proton pump inhibitors and the risk of hypomagnesemia: a systematic review and meta-analysis.

Park CH, Kim EH, Roh YH, Kim HY, Lee SK - PLoS ONE (2014)

Bottom Line: Pooled odds ratios with 95% confidence intervals were calculated using the random effects model.On meta-analysis, pooled odds ratio for PPI use was found to be 1.775 (95% confidence interval 1.077-2.924).However, significant heterogeneity among the included studies prevented us from reaching a definitive conclusion.

View Article: PubMed Central - PubMed

Affiliation: Division of Gastroenterology, Department of Internal Medicine, Severance Hospital, Institute of Gastroenterology, Yonsei University College of Medicine, Seoul, Korea.

ABSTRACT

Background: Although many case reports have described patients with proton pump inhibitor (PPI)-induced hypomagnesemia, the impact of PPI use on hypomagnesemia has not been fully clarified through comparative studies. We aimed to evaluate the association between the use of PPI and the risk of developing hypomagnesemia by conducting a systematic review with meta-analysis.

Methods: We conducted a systematic search of MEDLINE, EMBASE, and the Cochrane Library using the primary keywords "proton pump," "dexlansoprazole," "esomeprazole," "ilaprazole," "lansoprazole," "omeprazole," "pantoprazole," "rabeprazole," "hypomagnesemia," "hypomagnesaemia," and "magnesium." Studies were included if they evaluated the association between PPI use and hypomagnesemia and reported relative risks or odds ratios or provided data for their estimation. Pooled odds ratios with 95% confidence intervals were calculated using the random effects model. Statistical heterogeneity was assessed with Cochran's Q test and I2 statistics.

Results: Nine studies including 115,455 patients were analyzed. The median Newcastle-Ottawa quality score for the included studies was seven (range, 6-9). Among patients taking PPIs, the median proportion of patients with hypomagnesemia was 27.1% (range, 11.3-55.2%) across all included studies. Among patients not taking PPIs, the median proportion of patients with hypomagnesemia was 18.4% (range, 4.3-52.7%). On meta-analysis, pooled odds ratio for PPI use was found to be 1.775 (95% confidence interval 1.077-2.924). Significant heterogeneity was identified using Cochran's Q test (df = 7, P<0.001, I2 = 98.0%).

Conclusions: PPI use may increase the risk of hypomagnesemia. However, significant heterogeneity among the included studies prevented us from reaching a definitive conclusion.

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Flow diagram of studies included in the meta-analysis.PPI, proton pump inhibitor.
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pone-0112558-g001: Flow diagram of studies included in the meta-analysis.PPI, proton pump inhibitor.

Mentions: A flow diagram for our systematic review is shown in Fig. 1. In summary, 409 studies were identified by our literature search. After scanning titles and abstracts, we discarded 101 duplicate articles retrieved through multiple search engines. Another 295 irrelevant articles were excluded based on the titles and abstracts. The full texts of the 13 remaining articles were reviewed, and 4 non-pertinent articles were excluded. Of 4 excluded studies, three were non-comparative studies without control group and remaining one included none of the patients with hypomagnesemia in both treatment and control group.


The association between the use of proton pump inhibitors and the risk of hypomagnesemia: a systematic review and meta-analysis.

Park CH, Kim EH, Roh YH, Kim HY, Lee SK - PLoS ONE (2014)

Flow diagram of studies included in the meta-analysis.PPI, proton pump inhibitor.
© Copyright Policy
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4230950&req=5

pone-0112558-g001: Flow diagram of studies included in the meta-analysis.PPI, proton pump inhibitor.
Mentions: A flow diagram for our systematic review is shown in Fig. 1. In summary, 409 studies were identified by our literature search. After scanning titles and abstracts, we discarded 101 duplicate articles retrieved through multiple search engines. Another 295 irrelevant articles were excluded based on the titles and abstracts. The full texts of the 13 remaining articles were reviewed, and 4 non-pertinent articles were excluded. Of 4 excluded studies, three were non-comparative studies without control group and remaining one included none of the patients with hypomagnesemia in both treatment and control group.

Bottom Line: Pooled odds ratios with 95% confidence intervals were calculated using the random effects model.On meta-analysis, pooled odds ratio for PPI use was found to be 1.775 (95% confidence interval 1.077-2.924).However, significant heterogeneity among the included studies prevented us from reaching a definitive conclusion.

View Article: PubMed Central - PubMed

Affiliation: Division of Gastroenterology, Department of Internal Medicine, Severance Hospital, Institute of Gastroenterology, Yonsei University College of Medicine, Seoul, Korea.

ABSTRACT

Background: Although many case reports have described patients with proton pump inhibitor (PPI)-induced hypomagnesemia, the impact of PPI use on hypomagnesemia has not been fully clarified through comparative studies. We aimed to evaluate the association between the use of PPI and the risk of developing hypomagnesemia by conducting a systematic review with meta-analysis.

Methods: We conducted a systematic search of MEDLINE, EMBASE, and the Cochrane Library using the primary keywords "proton pump," "dexlansoprazole," "esomeprazole," "ilaprazole," "lansoprazole," "omeprazole," "pantoprazole," "rabeprazole," "hypomagnesemia," "hypomagnesaemia," and "magnesium." Studies were included if they evaluated the association between PPI use and hypomagnesemia and reported relative risks or odds ratios or provided data for their estimation. Pooled odds ratios with 95% confidence intervals were calculated using the random effects model. Statistical heterogeneity was assessed with Cochran's Q test and I2 statistics.

Results: Nine studies including 115,455 patients were analyzed. The median Newcastle-Ottawa quality score for the included studies was seven (range, 6-9). Among patients taking PPIs, the median proportion of patients with hypomagnesemia was 27.1% (range, 11.3-55.2%) across all included studies. Among patients not taking PPIs, the median proportion of patients with hypomagnesemia was 18.4% (range, 4.3-52.7%). On meta-analysis, pooled odds ratio for PPI use was found to be 1.775 (95% confidence interval 1.077-2.924). Significant heterogeneity was identified using Cochran's Q test (df = 7, P<0.001, I2 = 98.0%).

Conclusions: PPI use may increase the risk of hypomagnesemia. However, significant heterogeneity among the included studies prevented us from reaching a definitive conclusion.

Show MeSH