Intragastric volatile N-nitrosamines, nitrite, pH, and Helicobacter pylori during long-term treatment with omeprazole

Abstract Background & Aims: This study evaluated the effect of long-term gastric acid suppressive therapy with omeprazole on intragastric levels of carcinogenic N -nitrosamines and related parameters. Methods: Forty-five patients on long-term omeprazole medication (mean, 35 months) and 13 healthy subjects without medication participated. Volatile N -nitrosamines were determined in gastric juice and urine. Intragastric pH, nitrite, nitrate, and H. pylori status were determined. DNA isolated from gastric biopsy specimens was analyzed for precarcinogenic alkyl-DNA adducts. Results: The intragastric pH in patients was significantly higher compared with controls ( P = 0.0001). Gastric nitrite levels in patients were nonsignificantly higher. There was no difference in total levels of intragastric volatile N -nitrosamines between patients and controls, however, urinary N -nitrosodimethylamine excretion was higher in patients ( P = 0.001). On omeprazole, Helicobacter pylori –positive vs.–negative patients had a nonsignificantly higher intragastric nitrite level and higher urinary N -nitrosodimethylamine excretion. No alkyl-DNA adducts could be detected in gastric epithelium. Conclusions: Increased intragastric pH caused by long-term treatment with omeprazole does not result in increased intragastric levels of nitrite and volatile N -nitrosamines. The significantly higher urinary N -nitrosamine excretion implies the risk of increased endogenous formation of N -nitrosamines during long-term omeprazole treatment. This risk may be higher in H. pylori –positive patients. GASTROENTEROLOGY 2001;121:517-525