The association between antiulcer medication and initiation of cobalamin replacement in older persons

As chronic use of antiulcer medications might predispose older persons to c obalamin deficiency, we studied participants (> 65 years) in the clinical e xamination of the Canadian Study of Health and Aging to test the associatio n between the use of an antiulcer medication (histamine-2 blocker or proton pump inhibitor) at baseline with initiation of cobalamin replacement durin g the 5 year follow-up period. Of 1054 eligible subjects, 125 (11.7%) were taking an antiulcer medication at baseline. At follow-up, 49 (4.6%) had sta rted cobalamin replacement. Antiulcer medication use at baseline was signif icantly associated with the initiation of cobalamin therapy (odds ratio 2.5 6, 95% confidence interval 1.30-5.05), even after adjusting for age, gender and institutional residence (odds ratio 2.61, 95% confidence interval 1.31 -5.23). There is an independent association between the use of antiulcer me dication and initiation of cobalamin therapy. While the relationship is not unambiguously causal, this finding underscores the need for judicious pres cribing of antiulcer medications for older persons. (C) 2001 Elsevier Scien ce Inc. All rights reserved.