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Achlorhydria
Classification and external resources

Hydrogen chloride (major component of gastric acid)
ICD-10 K31.8
ICD-9 536.0
DiseasesDB 29513
eMedicine med/18
MeSH D000126

Achlorhydria (pronounced /eɪklɔərˈhaɪdriə/) and hypochlorhydria refer to states where the production of gastric acid in the stomach is absent or low, respectively. It is associated with various other medical problems.

Contents

Signs and symptoms

The decreased acid level itself can cause symptoms similar to gastroesophageal reflux disease, and impairs protein digestion by inhibiting the activation of the enzyme pepsin, whose activation is dependent upon a low gastric pH. Furthermore, low acid levels in the stomach are linked with bacterial overgrowth (as the stomach does not kill microbes normally present in food), which can manifest as diarrhea or decreased absorption of nutrients or vitamins. Risk of particular infections, such as Vibrio vulnificus (commonly from seafood) is increased. Even without bacterial overgrowth, low stomach acid can lead to nutritional deficiencies through malabsorption of basic electrolytes (magnesium, zinc, etc) and vitamins (including vitamin C, vitamin K, and the B complex of vitamins). Such deficiencies may be involved in the development of a wide range of pathologies, from fairly benign neuromuscular issues to life-threatening diseases. A person with achlorhydria can suffer from stomach pains caused by the digestion of food that is not properly broken down by gastric acid.

Causes

Diagnosis

90% of all patients with achlorhydria have detectable antibodies against the H+/K+ ATP-ase proton pump. The diagnosis is made if the gastric pH remains high (>4.0) despite maximum pentagastrin stimulation. High gastrin levels are often detected.

Treatment

Treatment focuses on addressing the underlying cause of symptoms. Many health practitioners recommend meal-time supplementation with betaine hydrochloride (also known as betaine HCL) to increase gastric acidity and allow for proper digestion. Betaine HCL should not be confused with betaine in the form of DMG (dimethylglycine) or TMG (trimethylglycine)[2], which are sweet-tasting and non-acidic. Unlike TMG/DMG, betaine HCL includes chloride, which breaks down into hydrochloric acid in the stomach, facilitating a lower pH and improving the breakdown of food. Betaine HCL is typically sold as a preparation containing pepsin, a digestive enzyme.

In addition to taking steps to lower the pH of the stomach, supplementation with minerals and vitamins such as vitamin B12 (which is poorly absorbed in achlorhydria/hypochlorhydria due to the absence of intrinsic factor) is usually recommended to compensate for malabsorption of nutrients. Foods with high microbial loads (including dairy products that intentionally contain microbes such as penicillin are usually avoided. Because the acidity of the stomach is a primary defense against infection of the gastrointestinal tract, antifungals, probiotics, and antibiotics may be needed to treat recurring infections.

Prognosis

Little is known on the prognosis of achlorhydria, although there have been reports of an increased risk of gastric cancer.[3]

References

  1. ^ El-Omar EM, Oien K, El-Nujumi A, et al (1997). "Helicobacter pylori infection and chronic gastric acid hyposecretion". Gastroenterology 113 (1): 15–24. doi:10.1016/S0016-5085(97)70075-1. PMID 9207257. 
  2. ^ http://www.lef.org/magazine/mag97/july97_cover2.htm
  3. ^ Svendsen JH, Dahl C, Svendsen LB, Christiansen PM (1986). "Gastric cancer risk in achlorhydric patients. A long-term follow-up study". Scand. J. Gastroenterol. 21 (1): 16–20. doi:10.3109/00365528609034615. PMID 3952447. 

See also

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Simple English

Achlorhydria and hypochlorhydria is when there is very little, or no gastric acid in the stomach. It can come with other medical problems.

Signs

The lowering acid level itself can make symptoms similar to gastroesophageal reflux disease, and hinders protein digestion by holding back the enzyme pepsin. Pepsin needs a low gastric PH to become active. Low acid levels in the stomach are also linked with bacteria growing too much, which can stop the body taking in nutrients or vitamins.


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