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The use of H(2)-receptor antagonists and/or PPIs may impair the absorption of protein-bound dietary vitamin B12 and could contribute to the development of vitamin B12 deficiency with prolonged use.[189] The studies reviewed in this article clearly show that omeprazole therapy will decrease the absorption of vitamin B12 by preventing its cleavage from dietary proteins.[190] A number of studies have shown an association of decreased B12 absorption with prolonged PPI use.[189,190] However, PPIs have been shown to affect B12 absorption in very short periods of time as well.[191,192] One study showed a 72% decrease in B12 absorption on 20 mg of omeprazole (Prilosec) and an 88% decrease in B12 absorption on 40 mg of omeprazole after only 2 weeks of treatment

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