title: Atrophic gastritis during long-term omeprazole therapy affects serum vitamin B12 levels.
abstract: BACKGROUND
  Omeprazole maintenance therapy for gastro-oesophageal reflux disease (GERD) has been associated with an increased incidence of atrophic gastritis in H. pylori-infected patients and with a decreased absorption of protein-bound, but not of unbound cobalamin.
  
  
  OBJECTIVE
  : To test the hypothesis that the combination of decreased cobalamin absorption and atrophic gastritis decreases serum cobalamin levels during omeprazole therapy.
  
  
  METHODS
  Forty-nine H. pylori-positive GERD patients were treated with omeprazole for a mean (+/- s.d.) period of 61 (25) months. At the start of omeprazole treatment (T0) and at the latest follow-up visit (T1), serum was obtained for measurement of cobalamin. Corpus biopsy specimens were obtained at entry and follow-up for histopathological scoring according to the updated Sydney classification.
  
  
  RESULTS
  At inclusion, none of the 49 patients had signs of atrophic gastritis. During follow-up, 15 patients (33%) developed atrophic gastritis, nine of whom had moderate to severe atrophy. These 15 patients did not differ from the other 34 patients with respect to age, serum cobalamin at T0 or the duration of follow-up. During follow-up, no change was observed in the median serum cobalamin level in the 34 patients without atrophy; (T0) 312 (136-716) vs. (T1) 341 (136-839) pmol/L (P=0.1). In the 15 patients who developed atrophy, a decrease in cobalamin was seen from 340 (171 to 787) at baseline to 285 (156-716) at latest follow-up (P < 0.01).
  
  
  CONCLUSIONS
  The development of atrophic gastritis during omeprazole treatment in H. pylori-positive GERD patients is associated with a decrease of serum vitamin B12 levels.
authors.affiliation: Department of Gastroenterology, Free University Hospital, Amsterdam, The Netherlands.
authors.forename: B E
authors.initials: BE
authors.lastname: Schenk
authors.forename: E J
authors.initials: EJ
authors.lastname: Kuipers
authors.forename: E C
authors.initials: EC
authors.lastname: Klinkenberg-Knol
authors.forename: E C
authors.initials: EC
authors.lastname: Bloemena
authors.forename: M
authors.initials: M
authors.lastname: Sandell
authors.forename: G F
authors.initials: GF
authors.lastname: Nelis
authors.forename: P
authors.initials: P
authors.lastname: Snel
authors.forename: H P
authors.initials: HP
authors.lastname: Festen
authors.forename: S G
authors.initials: SG
authors.lastname: Meuwissen
mesh_terms: D000042:Absorption; D000897:Anti-Ulcer Agents / Q000009:adverse effects* / Q000627:therapeutic use*; D015331:Cohort Studies; D004334:Drug Administration Schedule; D005260:Female; D005757:Gastritis, Atrophic / Q000097:blood* / Q000139:chemically induced*; D005764:Gastroesophageal Reflux / Q000097:blood / Q000188:drug therapy; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D009853:Omeprazole / Q000009:adverse effects* / Q000627:therapeutic use*; D011446:Prospective Studies; D014805:Vitamin B 12 / Q000097:blood* / Q000493:pharmacokinetics
chemical_list: D000897:Anti-Ulcer Agents; D009853:Omeprazole; D014805:Vitamin B 12