Achlorhydria

What is Achlorhydria?

Gastric acid is the liquid that your stomach produces. It’s made up of hydrochloric acid, potassium chloride, and sodium chloride. The hydrochloric acid plays a crucial role in breaking down our food and helps guard our body from harmful substances we might consume with our food or drink. This acid is mostly produced by the cells lining our stomach. If your body doesn’t produce enough hydrochloric acid or none at all, it’s called hypochlorhydria or achlorhydria respectively. These conditions usually indicate a deeper health issue.

What Causes Achlorhydria?

Achlorhydria, a condition where the stomach doesn’t produce enough acid, can be caused by various conditions or factors.

One cause is pernicious anemia, an immune response where the body creates antibodies that destroy specific cells in the stomach, leading to a type of inflammation called atrophic gastritis.

The use of certain medications, particularly proton pump inhibitors (PPIs), which decrease acid production in the stomach, can also lead to achlorhydria. While PPIs don’t have a high risk in short-term applications, their long-term use has been linked to this condition.

In addition, Achlorhydria can develop as a result of an infection with a bacteria called Helicobacter pylori. This bacteria inhibits the function of certain proteins in stomach cells, temporarily causing low stomach acid levels while promoting the bacteria’s growth. This growth may eventually lead to pathological conditions such as stomach cancer.

Individuals who have undergone a gastric bypass, a surgery to reduce food intake in patients with severe obesity, may also develop achlorhydria. This is because the absence of food in the reduced stomach lowers the secretion of a hormone called gastrin, leading to reduced acid production.

A tumor known as VIPoma could also result in achlorhydria. This tumor typically arises in the pancreas and secretes large amounts of a peptide hormone called VIP. This can lead to a variety of symptoms, including watery diarrhea, low potassium levels, achlorhydria, and high blood sugar and calcium levels.

Another potential cause of achlorhydria is hypothyroidism. Thyroid hormone plays a role in controlling stomach acid secretion, and thus low levels of this hormone can lead to reduced stomach acid.

Furthermore, radiation therapy to the stomach and certain forms of stomach cancer have been reported to cause achlorhydria, as suggested by animal studies.

Risk Factors and Frequency for Achlorhydria

A study was carried out on healthy individuals and those with stomach problems. The results showed a slightly higher rate of achlorhydria and hypochlorhydria (conditions related to stomach acid levels) in women, but the difference wasn’t significant. People under 60 had a 2.3% and 2% incidence of achlorhydria and hypochlorhydria respectively. However, in older individuals, the incidence increased to 5%, which is nearly three times higher.

A separate study on causes linked to the body attacking its own cells showed a connection between age and the presence of parietal cell autoantibodies. The presence of these autoantibodies increased with age, moving from 2.5% in people in their thirties to 12% in those in their eighties. Autoimmune gastritis, a condition where the immune system attacks the stomach, is commonly connected to other autoimmune conditions. It’s also part of a condition called autoimmune polyglandular syndrome type 3. It’s important to mention that no link has been found between pernicious anemia, a type of anemia that results from vitamin B12 deficiency, and certain genetic markers known as HLA types.

Signs and Symptoms of Achlorhydria

Achlorhydria is a condition that can have different symptoms depending on what caused it. These symptoms typically include:

• Epigastric pain (pain in the upper abdomen)
• Weight loss
• Heartburn
• Nausea
• Bloating
• Diarrhea
• Abdominal pain
• Acid regurgitation (acid reflux)
• Early satiety (feeling full quickly when eating)
• Vomiting
• Postprandial fullness (feeling full after eating)
• Constipation
• Dysphagia (difficulty swallowing)
• Glossitis (inflammation of the tongue)
• Decreased position and vibration sense

Testing for Achlorhydria

If doctors suspect achlorhydria, which is a medical condition where there’s no acid in your stomach, they will need to run several tests to confirm this and determine why it’s happening. Below are the different types of tests they might use:

-Antiparietal and anti-intrinsic factor antibody test: This is a blood test that checks for certain antibodies that can tell your doctor more about what’s happening in your stomach.

-Stomach biopsy: This procedure involves taking a small sample of tissue from your stomach to be examined more closely in a lab.

-Gastric pH monitoring: This test measures the acid level in your stomach to see if it’s lower than it should be.

-Serum pepsinogen level test: Pepsinogen is a type of enzyme found in your stomach, and a low level of it can indicate achlorhydria.

-Serum gastrin levels test: Gastrin is a hormone that controls the release of stomach acid. If this hormone’s levels are high (over 500 to 1000 pg/mL), it may hint at the presence of achlorhydria.

-Tests for H. pylori infection: H. pylori is a bacteria that’s often associated with stomach conditions. The tests for this can include a breath test, stool antigen test, and additional biopsy, as well as advanced testing methods such as polymerase chain reaction (PCR) or fluorescent in situ hybridization (FISH).

-Hemoglobin level test: This is a blood test that measures the amount of hemoglobin – a protein that carries oxygen in your blood. It’s not directly related to achlorhydria, but it can give your doctor a fuller picture of your overall health.

Treatment Options for Achlorhydria

Achlorhydria is a medical condition for which there is no specific treatment. However, if a patient is found to have H. pylori, a type of bacteria, it is recommended to remove it. Other treatments aim to manage the complications associated with achlorhydria. This can involve supplementing the patient’s diet with certain elements or vitamins, such as calcium, vitamin D, iron, and vitamin B12.

While there are no detailed guidelines for monitoring achlorhydria, it’s crucial to note that it is a condition that could lead to the development of tumors. In 2015, the Kyoto consensus stated that patients who have undergone treatment to remove H. pylori and were found to have a pre-tumor condition should engage in regular check-ups involving endoscopy. Endoscopy is a procedure where doctors look directly at your digestive tract using a flexible tube with a camera.

What else can Achlorhydria be?

• Type IV Mucolipidosis
• B12 Deficiency Anemia (Pernicious Anemia)
• VIP-secreting tumors (VIPomas)

What to expect with Achlorhydria

While achlorhydria has the potential to develop into serious conditions like gastric adenocarcinoma and gastric carcinoid tumor, its outlook is generally positive.

Possible Complications When Diagnosed with Achlorhydria

The main complications of a health condition called achlorhydria mainly stem from a deficiency of certain nutrients. These complications are more frequent compared to others.

• Iron deficiency
• Vitamin-B12 deficiency
• Vitamin-D and calcium deficiency, which can lead to weakened bones and fractures (osteoporosis)
• A stomach cancer known as gastric adenocarcinoma
• A type of stomach tumor called gastric carcinoid tumor
• An issue known as small intestinal bacterial overgrowth syndrome

Preventing Achlorhydria

Patients are informed that some medications may not be absorbed effectively in the body due to an increase in stomach acidity levels. As a result, these drugs are often administered at higher doses to ensure their effectiveness.