The formation of N-nitroso compounds is greatest among individuals who are achlorhydric (have very low levels of hydrochloric acid in the stomach) [1, 13].
Ulcers are not found in achlorhydric patients and almost always occur in patients with Zollinger Ellison syndrome which is characterized by very high acid secretion.1 Inhibition of over production of acid is a desirable therapeutic goal in the treatment of peptic ulcer.
Other factors that increase vulnerability to TD are immunodeficiency, achlorhydric states such as atrophic gastritis, and chronic use of proton pump inhibitors.