Absorption of nonheme iron during gastric acid suppression in patients with hereditary hemochromatosis and healthy controls

W. Moris, P.L.M. Verhaegh, J. Verbeek, D.W. Swinkels, C.M. Laarakkers, A.A.M. Masclee, G.H. Koek, C.T.B.M. van Deursen*

*Corresponding author for this work

Research output: Contribution to journalArticleAcademicpeer-review


Phlebotomies are performed in hereditary hemochromatosis (HH) to maintain normal iron concentrations. Proton-pump inhibitors (PPIs) can reduce the number of phlebotomies in patients with HH. However, in patients without HH, the iron concentrations do not appear to be compromised when using PPIs. Therefore, we aim to explain the differences in iron absorption between patients with and without HH. In 10 p.cysteine282tyrosine (p.C282Y) homozygous HH patients with normalized iron stores and 10 healthy control subjects (HCs), the iron parameters and hepcidin concentrations were determined before ingestion of a pharmacological dose of 50 mg iron [ferric iron (Fe3 thorn )] polymaltose and hourly for 4 h afterward. This was repeated after 7 days of treatment with pantoprazole 40 mg once daily. Serum iron concentrations and transferrin saturation percentages dropped significantly during PPI use in the patients with HH, whereas no changes were observed in the HCs. Hepcidin concentrations were lower in the patients with HH compared with the HCs both before and during PPI use. In both groups, hepcidin levels did not significantly decrease during the treatment. Seven-day PPI use significantly reduces iron absorption in patients with HH but not in HCs. Changes in hepcidin concentrations could not explain these different PPI effects on iron absorption probably due to a small sample size. NEW & NOTEWORTHY This study confirms that lowering gastric acidity by proton pump inhibitors results in a reduction in iron absorption in patients with hemochromatosis and not in healthy control subjects. The presupposition that a decrease in hepcidin concentration in healthy control subjects in response to lowering gastric acidity can explain the difference in iron absorption between these groups could not be confirmed probably because of a small sample size.
Original languageEnglish
Pages (from-to)G1105-G1110
Number of pages6
JournalAmerican Journal of Physiology-Gastrointestinal and Liver Physiology
Issue number6
Publication statusPublished - 1 Jun 2021


  • hepcidin
  • hereditary hemochromatosis
  • iron absorption
  • iron overload
  • proton-pump inhibitors
  • HFE

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