Mechanisms of proton pump inhibitor-induced hypomagnesemia.
Level 5 - mechanism / opinion, no new human data
Narrative review synthesizing mechanisms without original clinical data
PubMed 35652564 · doi:10.1111/apha.13846
What was done
This narrative review synthesized experimental and clinical evidence regarding the physiological mechanisms underlying proton pump inhibitor (PPI)-induced hypomagnesemia (defined as serum Mg2+ <0.7 mmol/L), focusing on intestinal absorption, luminal pH, mucosal transporters, and gut microbiota.
What was found
The abstract reports no quantitative values or effect estimates. It notes that low urinary Mg2+ excretion in affected PPI users indicates renal compensation for intestinal malabsorption. The authors identify reduced luminal Mg2+ solubility due to increased pH, altered transporter expression and activity in the small intestine and colon, and PPI-related gut microbiome alterations as key contributing mechanisms.
Why it matters
The review summarizes how elevated luminal pH and microbiome dysbiosis disrupt intestinal magnesium uptake during PPI therapy. It suggests that dietary fiber interventions aimed at microbial fermentation and luminal acidification could be a potential therapeutic strategy.
Limits
This is a narrative review with no original human dataset, systematic search protocol, or meta-analytic pooling. Specific sample sizes, effect magnitudes, and clinical validation of the suggested dietary intervention are not provided in the abstract.
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