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Comment & Response
April 9, 2014

Gastric Acid–Inhibiting Medications and Vitamin B12 Deficiency—Reply

Author Affiliations
  • 1Division of Research, Kaiser Permanente, Oakland, California
JAMA. 2014;311(14):1445-1446. doi:10.1001/jama.2014.2101

In Reply Drs Dharmarajan and Norkus raise the question of how to define vitamin B12 deficiency. We share this concern; thus, we performed sensitivity analyses including both a broader definition (which included International Classification of Diseases coding) and a narrower definition (which included only patients who had both a low vitamin B12 level and who were prescribed vitamin B12 supplementation). An association between long-term use of acid-suppressing medications and vitamin B12 deficiency was found with different definitions; thus, there was no evidence that the main finding was explained only by the case definition. However, we did not have dietary data for the patients.

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