Abstract
Markedly decreased acid secretion is known to decrease vitamin B~2 absorption. However, it is controversial whether prolonged treatment with potent gastric antisecretory drugs will caused decreased serum vitamin Btz levels (Bt2 levels). This could be a potentially important problem in conditions such as GERD or ZES, requiring continuous long-term treatment. In a previous study we reported that B~z levels, but not serum folate levels, determined at one time correlated inversely with the length of omeprazole treatment in patients with ZES. In the present study to provide insights into the possible effects of long-term acid suppression on B~2 levels in a given patient, we have analyzed sequential results from 68 patients with ZES who were followed for at least 5 years. Patients had yearly B~ levels and determinations of acid secretory control taken one hour before the next dose of antisecretory drug. The mean age of the patients was 55 ± 1 yrs, there were 22 females and 46 males, and the total duration of gastric antisecretory treatment was 14 _+0.5 yrs. Fifty-two patients were being treated with omeprazole (mean time ± 1SEM=5 ± 1 yrs) and 17 patients with histamine Hz inhibitors. The mean initial B~2 level was 439 ± 21 pg/ml (normal=165-1000 pg/ml) and the last Ba2 level, a mean of 6.3 ± 1.2 yrs later, was 427 ± 21 pg/ml, was not significantly different. The patients had a mean basal acid output of 25 ± 2 mEq/h and M An of 54-+ 4 mEq/h. The patients' acid secretory rate on antisecretory drug for each of the last 5 years was reviewed and 21/68 (30%) had complete achlorhydria defined as no basal acid secretion during each of the last 3 years. The B~ levels over the 6.3 ± 1.1 yrs from the first to the last Bl~ level in the achlorhydric patients showed a highly significant (p=0.001) decrease from 419 _+ 38 to 305 ± 24 pg/ml. In contrast, for the 47 patients without complete achlorhydria over a 6.3 ± 1.2 year period of antisecretory drug treatment, the B~2 levels did not change significantly (447 ± 26 vs 480 ± 35 pg/ml). A significantly higher proportion (p=0.002) [18/21 (86%)] of patients with complete achlorhydria had a decrease in their B~2 levels over this time period compared to the patients without achlorhydria [22/47 (47%)]. These results demonstrate that profound acid inhibition, which occurs in 32% of patients with ZES, lead to a highly significant decrease in serum vitamin levels over a 6-year period. In other studies > 80% of patients with GERD treated long-term with potent antisecretory drugs also have such acid hyposecretion that hypergastrinemia develops. These results suggest that in patients with such conditions as ZES or GERD undergoing prolonged daily treatment with potent gastric acid suppressants such as omeprazole or lansoprazole, routine monitoring of B~2 levels should be considered.
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