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Meta-Analysis
. 2019 Mar;98(13):e15011.
doi: 10.1097/MD.0000000000015011.

Does the use of proton pump inhibitors increase the risk of hypomagnesemia: An updated systematic review and meta-analysis

Shengtao Liao  1 , Li Gan  2 , Zhechuan Mei  1
Affiliations
Meta-Analysis

Does the use of proton pump inhibitors increase the risk of hypomagnesemia: An updated systematic review and meta-analysis

Shengtao Liao et al. Medicine (Baltimore). 2019 Mar.

Abstract

Background: Proton pump inhibitors (PPIs) are commonly used in the treatment of acid-related diseases; however, the association between the use of PPIs and potential risk of hypomagnesemia is controversial.

Methods: In the present study, databases including PubMed, EMBASE, MEDLINE, PsycINFO, CINAHL, the Cochrane Library, and 4 Chinese databases were searched since the inception until April 2018. Previous observational studies on the incidence of hypomagnesemia in individuals exposed to PPIs were included.

Results: This systematic review involved 15 studies including 129,347 participants, and the sample size varied from 52 to 95,205. Meta-analysis of 14 studies indicated that the use of PPIs increased the risk of hypomagnesemia [RR, 1.44, 95% CI, 1.13-1.76; I, 85.2%]. Subgroup analysis revealed that the use of PPI was not associated with the incidence of hypomagnesemia in outpatients [RR, 1.49; 95% CI, 0.83-2.14; I, 41.4%] and hospitalized patients [RR, 1.05; 95% CI, 0.81-1.29; I, 62.1%], respectively. The use of PPIs was not related to the risk of hypomagnesemia based on the cut-off values of 1.8 mg/dL [RR, 1.73; 95% CI, 0.87-2.58; I, 65.2%], 1.7 mg/dL [RR, 1.48; 95% CI, 0.90-2.06; I, 87.6%], and 1.6 mg/dL [RR, 0.98; 95% CI, 0.69-1.27; I, 67.9%].

Conclusion: The association between the exposure to PPI and the incidence of hypomagnesemia remained unclear. Due to the remarkable heterogeneity in previous studies, a definitive conclusion could not be drawn. Further research should be conducted to investigate the relationship between the use of individual PPI and potential risk of hypomagnesemia, and a dose-response analysis may be required.

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Conflict of interest statement

The authors have no conflicts of interest to disclose.

Figures

Figure 1
Figure 1
Flowchart of the literature screening.
Figure 2
Figure 2
The risk of hypomagnesemia in PPI users. PPI = proton pump inhibitors.
Figure 3
Figure 3
The incidence of hypomagnesemia in PPI users with various setting. PPI = proton pump inhibitors.
Figure 4
Figure 4
The risk of hypomagnesemia in PPI users at different cut-off values. PPI = proton pump inhibitors.
Figure 5
Figure 5
The incidence of hypomagnesemia in PPI users with a variety of study types. [RR, 1.62; 95% CI, 1.27 to 1.97; I2, 83.6%]. [RR, 1.37; 95% CI, 0.23 to 2.51; I2, 35.7%]. PPI = proton pump inhibitors, CIs = confidence intervals, RR = relative risks.
See this image and copyright information in PMC

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