RELATIONSHIP BETWEEN HYPOMAGNESEMIA FOLLOWING CHRONIC USE OF PROTON PUMP INHIBITORS

Abstract

Background: Proton pump inhibitors (PPIs) are widely prescribed for acid-related disorders, with chronic use becoming increasingly prevalent. While generally considered safe, prolonged PPI therapy has been associated with electrolyte disturbances, particularly hypomagnesemia. Magnesium plays a crucial role in neuromuscular function, enzymatic activity, and cellular homeostasis, and its deficiency can lead to significant clinical complications. Despite the growing recognition of PPI-induced hypomagnesemia, limited research has explored this association in community-based populations, necessitating further investigation into the long-term effects of PPIs on serum magnesium levels.

Objective: To evaluate the relationship between hypomagnesemia and chronic PPI use in a community-based population, assessing serum magnesium levels in patients with varying durations of therapy.

Methods: This prospective observational study was conducted at the Department of Medicine, Pak-Emirates Military Hospital (PEMH), Rawalpindi, from July 2023 to June 2024. A total of 310 patients were included in the final analysis, categorized based on PPI use duration: 6–12 months (n=110), 12–24 months (n=136), and more than 24 months (n=64). Patients underwent monthly follow-up for six months, with serial assessments of complete blood count, renal function tests, and serum magnesium levels. Statistical analysis was performed using ANOVA to compare magnesium levels across different duration groups, with a p-value ≤0.05 considered significant.

Results: The mean serum magnesium levels at six-month follow-up were significantly lower with increasing PPI duration: 1.48 ± 0.08 mg/dL in the 6–12 month group, 1.31 ± 0.12 mg/dL in the 12–24 month group, and 1.28 ± 0.09 mg/dL in the group using PPIs for more than 24 months (p<0.001). The decline followed a linear trend, highlighting a strong association between prolonged PPI use and magnesium depletion.

Conclusion: Chronic PPI use is associated with a progressive decline in serum magnesium levels, with a more pronounced reduction observed in patients with extended therapy durations. These findings emphasize the need for routine magnesium monitoring in long-term PPI users to mitigate potential complications.