The association between the use of proton pump inhibitors and the risk of hypomagnesemia

A systematic review and meta-analysis

Chan Hyuk Park, Eun Hye Kim, Yun Ho Roh, Ha Yan Kim, SangKil Lee

Research output: Contribution to journalReview article

59 Citations (Scopus)

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.

Original languageEnglish
Article numbere112558
JournalPLoS One
Volume9
Issue number11
DOIs
Publication statusPublished - 2014 Nov 13

Fingerprint

hypomagnesemia
Proton Pump Inhibitors
systematic review
meta-analysis
Meta-Analysis
Odds Ratio
odds ratio
Dexlansoprazole
Rabeprazole
Esomeprazole
Confidence Intervals
relative risk
Lansoprazole
Proton Pumps
Omeprazole
confidence interval
MEDLINE
Magnesium
Libraries
proton pump inhibitors

All Science Journal Classification (ASJC) codes

  • Biochemistry, Genetics and Molecular Biology(all)
  • Agricultural and Biological Sciences(all)

Cite this

@article{16d5611a812c433f9e893ae6e1cb3981,
title = "The association between the use of proton pump inhibitors and the risk of hypomagnesemia: A systematic review and meta-analysis",
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.",
author = "Park, {Chan Hyuk} and Kim, {Eun Hye} and Roh, {Yun Ho} and Kim, {Ha Yan} and SangKil Lee",
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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, Chan Hyuk; Kim, Eun Hye; Roh, Yun Ho; Kim, Ha Yan; Lee, SangKil.

In: PLoS One, Vol. 9, No. 11, e112558, 13.11.2014.

Research output: Contribution to journalReview article

TY - JOUR

T1 - The association between the use of proton pump inhibitors and the risk of hypomagnesemia

T2 - A systematic review and meta-analysis

AU - Park, Chan Hyuk

AU - Kim, Eun Hye

AU - Roh, Yun Ho

AU - Kim, Ha Yan

AU - Lee, SangKil

PY - 2014/11/13

Y1 - 2014/11/13

N2 - 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.

AB - 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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U2 - 10.1371/journal.pone.0112558

DO - 10.1371/journal.pone.0112558

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