Achlorhydria
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Achlorhydria | |
---|---|
Other names | Hypochlorhydria |
Hydrogen chloride (major component of gastric acid) | |
Pronunciation | |
Specialty | Internal medicine |
Symptoms | Most of the time none, but may cause and not limited to, heartburn, stomach pain, and early satiety |
Complications | Anemia, small intestinal bacterial overgrowth |
Causes | Pernicious anemia, helicobacter pylori infection, hypothyroidism, stomach surgery, nutritional deficiencies, and long term use of medications to treat heartburn |
Achlorhydria and hypochlorhydria refer to states where the production of hydrochloric acid in gastric secretions of the stomach and other digestive organs is absent or low, respectively.[1] It is associated with various other medical problems.
Signs and symptoms
Irrespective of the cause, achlorhydria can result as known complications of
- gastroesophageal reflux disease[2]
- abdominal discomfort
- early satiety
- weight loss
- diarrhea
- constipation
- abdominal bloating
- anemia
- stomach infection
- malabsorption of food
- carcinoma of stomach
Since acidic pH facilitates the absorption of iron, achlorhydric patients often develop
Bacterial overgrowth and
Risk of particular infections, such as
Causes
- The slowing of the body's basal metabolic rate associated with hypothyroidism.
- Pernicious anemia where there is antibody production against parietal cells which normally produce gastric acid.[3]
- The use of proton pump inhibitors).
- A symptom of rare diseases such as mucolipidosis (type IV).
- A symptom of Helicobacter pylori infection which neutralizes and decreases secretion of gastric acid to aid its survival in the stomach.[4]
- A symptom of atrophic gastritis or of stomach cancer.
- Radiation therapy involving the stomach.
- Gastric bypass procedures such as a duodenal switchand RNY, where the largest acid producing parts of the stomach are either removed or blinded.
- VIPomas (vasoactive intestinal peptides) and somatostatinomas are both islet cell tumors of the pancreas.
- Pellagra, caused by niacin deficiency.
- Chloride, sodium, potassium, zinc and/or iodine deficiency, as these elements are needed to produce adequate levels of stomach acid(HCl).
- autoimmune disorderthat destroys many of the body's moisture-producing enzymes.
- Ménétrier's disease, characterized by hyperplasia of mucous cells in the stomach also causing excess protein loss, leading to hypoalbuminemia (presents with abdominal pain and edema).
Risk Factors
Prevalence
Achlorhydria is present in about 2.5% of the population under 60 years old and about 5% of the population over 60 years old.[5] The incidence increases to around 12% in populations over 80 years old. An absence of hydrochloric acid increases with advancing age. A lack of hydrochloric acid produced by the stomach is one of the most common age-related causes of a harmed digestive system.[6]
Among men and women, 27% experience a varying degree of achlorhydria. US researchers found that over 30% of women and men over the age of 60 have little to no acid secretion in the stomach. Additionally, 40% of postmenopausal women have shown to have no basal gastric acid secretion in the stomach, with 39.8% occurring in females 80 to 89 years old.[6]
Comorbidities
Thyroid hormones can contribute to changes in the level of hydrochloric acid in the stomach. Hypothyroidism is associated with a greater risk of developing achlorhydria.[5]
Long term usage of medications or drugs
Extended use of anti-acids, antibiotics, and other drugs can contribute to hypochlorhydria. Proton pump inhibitors (PPIs) are very commonly used to temporarily relieve symptoms conditions such as gastroesophageal reflux and peptic ulcers.[7] Risk increases as these drugs are taken over a longer time period, often many years, typically beyond the recommended therapeutic usage.
Stress can also be linked to symptoms associated with achlorhydria including constant belching, constipation, and abdominal pain.[7]
Diagnosis
For practical purposes, gastric pH and endoscopy should be done in someone with suspected achlorhydria. Older testing methods using fluid aspiration through a nasogastric tube can be done, but these procedures can cause significant discomfort and are less efficient ways to obtain a diagnosis.
A complete 24-hour profile of gastric acid secretion is best obtained during an esophageal pH monitoring study.
Achlorhydria may also be documented by measurements of extremely low levels of pepsinogen A (PgA) (< 17 µg/L) in blood serum. The diagnosis may be supported by high serum gastrin levels (> 500–1000 pg/mL).[8]
The "Heidelberg test" is an alternative way to measure stomach acid and diagnose hypochlorhydria/achlorhydria.
A check can exclude deficiencies in iron, calcium,
Once achlorhydria is confirmed, a hydrogen breath test can check for bacterial overgrowth.
Treatment
Treatment focuses on addressing the underlying cause of symptoms.
Treatment of gastritis that leads to
Achlorhydria associated with Helicobacter pylori infection may respond to H. pylori eradication therapy, although resumption of gastric acid secretion may only be partial and it may not always reverse the condition completely.[9]
Antimicrobial agents, including metronidazole, amoxicillin/clavulanate potassium, ciprofloxacin, and rifaximin, can be used to treat bacterial overgrowth.
Achlorhydria resulting from long-term proton-pump inhibitor (PPI) use may be treated by dose reduction or withdrawal of the PPI.
Prognosis
Little is known on the prognosis of achlorhydria, although there have been reports of an increased risk of gastric cancer.[10]
A 2007 review article noted that non-Helicobacter bacterial species can be cultured from achlorhydric (pH > 4.0) stomachs, whereas normal stomach pH only permits the growth of Helicobacter species. Bacterial overgrowth may cause false-positive H. pylori test results due to the change in pH from urease activity.[11]
Small bowel bacterial overgrowth is a chronic condition. Retreatment may be necessary once every 1–6 months.[12] Prudent use of antibacterials now calls for an antimicrobial stewardship policy to manage antibiotic resistance.[13]
See also
References
- ^ Kohli, Divyanshoo R., Jennifer Lee, and Timothy R. Koch. "Achlorhydria." Medscape. Ed. B S. Anand. N.p., 29 Apr. 2015. Web. 25 May 2015.
- ^ Kines, Kasia, and Tina Krupczak. "Nutritional Interventions for Gastroesophageal Reflux, Irritable Bowel Syndrome, and Hypochlorhydria: A Case Report." Integr Med. 2016 Aug 15; 15(4): 49-53.
- ^ "Achlorhydria". Medscape. Jul 15, 2016. Retrieved 11 October 2018.
- PMID 9207257.
- ^ a b c d Team 2, Health Jade (2019-09-02). "Achlorhydria definition, causes, symptoms, diagnosis, treatment & prognosis". Health Jade. Retrieved 2019-11-15.
{{cite web}}
: CS1 maint: numeric names: authors list (link) - ^ a b English, James (2018-11-25). "Gastric Balance: Heartburn Not Always Caused by Excess Acid". Nutrition Review. Retrieved 2019-11-15.
- ^ PMID 27574495.
- ^ Divyanshoo Rai Kohli. "Achlorhydria Workup". Medscape. Retrieved 13 September 2014.
- PMID 15153171.
- PMID 3952447.
- S2CID 205786158.
- ^ Divyanshoo Rai Kohli. "Achlorhydria Follow-up". Medscape. Retrieved 13 September 2014.
- PMID 24036486.