Achlorhydria: what is it, causes, symptoms, treatment, prognosis

What is achlorhydria?

Achlorhydriaand hypochlorhydria refer to conditions in which the production of hydrochloric acid in the gastric secretion of the stomach and other digestive organs is absent or low, respectively. It has been linked to various other medical problems.

Signs and symptoms

Regardless of the cause, achlorhydria can result from known complications such as bacterial overgrowth and intestinal metaplasia, and symptoms often correspond to these conditions:

• gastroesophageal reflux disease;
• abdominal discomfort;
• early satiety;
• weight loss;
• diarrhea;
• constipation;
• bloating;
• anemia;
• stomach infection;
• violation of food absorption;
• stomach cancer.

Because acidic pH promotes iron absorption, patients with achlorhydria often develop Iron-deficiency anemia. The acidic environment of the stomach promotes the conversion of pepsinogen to pepsin, which is very important for the digestion of protein into smaller ones. components such as complex protein into simple peptides and amino acids inside the stomach, which are later absorbed in the gastrointestinal path.

Bacterial overgrowth and B12 deficiency (pernicious anemia) can cause nutritional deficiencies trace elements, which leads to various clinical neurological manifestations, including visual changes, paresthesias, ataxia, limb weakness, gait disturbance, memory defects, hallucinations, as well as changes in personality and mood.

The risk of contracting certain infections, such as Vibrio vulnificus (usually seafood). Even without bacterial overgrowth, low stomach acid levels (high pH) can lead to a deficiency nutrients due to decreased absorption of essential electrolytes (magnesium, zinc, etc.) and vitamins (including vitamin C, vitamin K and vitamin B complex). Such deficiencies can be responsible for the development of a wide range of pathologies, from fairly benign neuromuscular problems to life-threatening diseases.

Causes

Achlorhydria and hypochlorhydria can be caused by:

• slowing down the basal metabolism in the body, associated with hypothyroidism;
• pernicious anemia, in which antibodies are produced against parietal cells that normally produce stomach acid;
• the use of antacids or drugs that reduce the production of acid in the stomach (for example, H2-receptor antagonists) or transport (for example, proton pump inhibitors);
• a symptom of a rare disease such as mucolipidosis (type IV);
• symptom of infection Helicobacter pylori, which neutralizes and reduces gastric acid secretion to aid its survival in the stomach;
• symptoms of atrophic gastritis or stomach cancer;
• radiation therapy with stomach damage;
• gastric bypass procedure;
• VIPomai (secreting vasoactive intestinal peptide) and somatostatinoma, which are islet tumors pancreas;
• pellagra caused by niacin deficiency;
• deficiency of chlorides, sodium, potassium, zinc and / or iodine, since these elements are necessary for the production of sufficient levels of acid in the stomach;
• Sjogren's syndrome, autoimmune diseasewhich destroys many of the enzymes that produce moisture in the body;
• Menetrie's diseasecharacterized by hyperplasia of gastric mucous cells, also causes excessive protein loss, which leads to hypoalbuminemia. Abdominal pain and swelling are present.

Risk factors

— Age.

It was found that the incidence of achlorhydria in patients under the age of 60 was about 2.3%, while in patients over 60 years of age it was 5%. In persons of 30 years of age, the prevalence is about 2.5% and increases to 12% in persons of the 80s.

The lack of hydrochloric acid increases with age. Lack of hydrochloric acid produced by the stomach is one of the most common age-related causes of digestive disorders.

Among men and women, 27% suffer from achlorhydria to one degree or another. American researchers found that more than 30% of women and men over 60 suffer from little or no stomach acid secretion. In addition, 40% of postmenopausal women do not have the main secretion of gastric acid in the stomach, with 39.8% among women aged 80 to 89 years.

- Autoimmune diseases.

Autoimmune diseases also associated with old age, especially with autoimmune gastritiswhen the body produces unwanted antibodies and causes stomach inflammation. Autoimmune disorders also cause small bacterial growth in the gut and vitamin B12 deficiency. They also appear to be factors in the secretion of acid in the stomach.

Hypothyroidism: Thyroid hormones are a factor in reducing the level of hydrochloric acid in the stomach, therefore hypothyroidism is associated with an increased risk of developing achlorhydria.

Autoimmune conditions are often treated with a variety of treatments, however, these treatments have no known effect on achlorhydria.

- Other.

Other risk factors include over-the-counter anti-acid drugs, and antibiotics, which can be used to block stomach acid. These medicines are often taken by people for longer than the recommended period, even for many years, despite the fact that they have an adverse effect on gastric acid secretion.

Stress has been shown to be associated with symptoms associated with achlorhydria, including persistent burp, constipation and abdominal pain.

Diagnostics

For practical purposes, a patient with suspected achlorhydria should undergo gastric pH measurement and endoscopy. Older research methods can be performed using aspiration of fluid through a nasogastric tube, but these procedures can cause significant discomfort and are less effective methods of staging diagnosis.

The complete 24-hour gastric acid secretion profile is best obtained during an esophageal pH monitoring study.

Achlorhydria can also be detected by detecting extremely low levels of pepsinogen A (<17 μg / L) in serum. The diagnosis can be confirmed by high serum gastrin levels (> 500-1000 pg / ml).

After confirming achlorhydria with a hydrogen breath test, bacterial overgrowth can be checked.

Treatment

There is no specific treatment for achlorhydria. Treatment is aimed at addressing the root cause of the symptoms.

Gastritis treatment, leading to pernicious (pernicious) anemia, consists in parenteral administration of vitamin B12. Associated immune-mediated conditions (e.g., insulin-dependent diabetes, autoimmune thyroiditis). However, the treatment of these diseases has no known effect in the treatment of achlorhydria.

Achlorhydria associated with infection Helicobacter pylori, may respond to eradication therapy H. pylori, although the resumption of gastric acid secretion may only be partial and may not always completely change the condition.

Antimicrobial agents, including metronidazole, amoxicillin / potassium clavulanate, ciprofloxacin, and rifaximin, can be used to treat bacterial overgrowth.

Achlorhydria resulting from long-term use of a proton pump inhibitor (PPI) can be treated with dose reduction or discontinuation of the PPI.

Forecast

Little is known about the prognosis of achlorhydria, although there have been reports of an increased risk of stomach cancer.

A 2007 review article noted that non-bacterial species Helicobacter, can be cultured from a patient with achlorhydria (pH> 4.0) stomach, whereas the normal pH of the stomach allows only the growth of species Helicobacter. Bacterial overgrowth can cause false positive test results for H. pylori as a result of pH changes due to urease activity.

Complications

Most of the complications found in achlorhydria are due to nutritional deficiencies. They are also more common than other complications.

• Iron deficiency.
• Vitamin B12 deficiency.
• Deficiency of vitamin D and calcium, leading to osteoporosis and broken bones.
• Adenocarcinoma of the stomach.
• Carcinoid tumor of the stomach.
• Small intestine bacterial overgrowth syndrome.