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Achlorhydria and hypochlorhydria are states where the production of hydrochloric acid in gastric secretions of the stomach is absent or low, respectively.Kohli, Divyanshoo R., Jennifer Lee, and Timothy R. Koch. "Achlorhydria." Medscape. Ed. B S. Anand. N.p., 29 Apr. 2015. Web. 25 May 2015. Achlorhydria is commonly a complication of some other disease, such as chronic Helicobacter pylori infection or autoimmune pernicious anemia, as well as a possible side effect of long-term use of proton pump inhibitors.
Complications of achlorhydria most frequently include small intestinal bacterial overgrowth and the nutritional deficiencies that can result from it. Rarely, achlorhydria may contribute to formation of Stomach cancer or gastric Carcinoid.
Since acidic pH facilitates iron absorption, achlorhydric patients often develop iron deficiency anemia.
Bacterial overgrowth, the most frequent complication of achlorhydria, can cause micronutrient deficiencies such as B12 deficiency and other nutrient deficiencies that result in various clinical neurological manifestations, including visual changes, paresthesias, ataxia, limb weakness, gait disturbance, memory defects, hallucinations and personality and mood changes. Nutritional deficiencies are the most common complication of achlorhydria. Even without bacterial overgrowth, low stomach acid (high pH) 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).
Risk of particular infections, such as Vibrio vulnificus (commonly from seafood) and Vibrio cholerae is increased.
Achlorhydria is present in about 2.5% of the population under 60 years old and about 5% of the population over 60 years old. 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.
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.
Comorbidities
Autoimmune disorders are also linked to advancing age, specifically autoimmune gastritis, which is when the body produces unwelcome antibodies and causes inflammation of the stomach. Autoimmune disorders are also a cause for small bacterial growth in the bowel and a deficiency of Vitamin B-12. These have also proved to be factors of acid secretion in the stomach. Autoimmune conditions can often be managed with various treatments; however, little is known about how or if these treatments effect achlorhydria.
Thyroid hormones can contribute to changes in the level of hydrochloric acid in the stomach, with unpredictable but strong fluctuations observed in states of both hypothyroidism and hyperthyroidism.
Long-term usage of medications or drugs
Extended use of antacids, antibiotics, and other drugs can contribute to hypochlorhydria. Proton pump inhibitors (PPIs) are very commonly used to temporarily relieve symptoms and conditions such as gastroesophageal reflux and peptic ulcers. Risk increases as these drugs are taken over a longer 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.
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) () in blood serum. The diagnosis may be supported by high serum gastrin levels ().
The "Heidelberg test" is an alternative way to measure stomach acid and diagnose hypochlorhydria/achlorhydria.
A check can exclude deficiencies in iron, calcium, prothrombin time, vitamin B-12, vitamin D, and thiamine. Complete blood count with indices and peripheral smears can be examined to exclude anemia. Elevation of serum folate is suggestive of small bowel bacterial overgrowth. Bacterial folate can be absorbed into the circulation.
Once achlorhydria is confirmed, a hydrogen breath test can check for bacterial overgrowth.
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. Patients with known or suspected H. pylori infection should be followed and Endoscopy evaluated over time, due to the risk of recurrence as well as potential gastric malignancy.
Antimicrobial agents, including rifaximin, metronidazole, amoxicillin/clavulanate potassium, ciprofloxacin, and others, can be used to treat bacterial overgrowth. Of these, rifaximin is the most well-studied and frequently used treatment for SIBO.
Achlorhydria resulting from long-term proton-pump inhibitor (PPI) use may be treated by dose reduction or withdrawal of the PPI.
SIBO is a chronic condition. Retreatment may be necessary once every 1–6 months. Prudent use of antibacterials now calls for an antimicrobial stewardship policy to manage antibiotic resistance.
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