Achlorhydria

Achlorhydria: Description, Causes and Risk Factors:

Absence of hydrochloric acid (HCl) from the gastric juice.Achlorhydria refers to states where the production of gastric acid in the stomach is absent or low, respectively. It is associated with various other medical problems.Causes & Risk Factors:The slowing of the body's basal metabolic rate (BMR) associated with hypothyroidism.
  • Autoimmune disorders where there is antibody production against parietal cells which normally produce gastric acid.
  • The use of antacids or drugs that decrease gastric acid production (such as H2-receptor antagonists) or transport (such as proton pump inhibitors).
  • A symptom of rare diseases such as mucolipidosis (type IV).
  • A symptom of Helicobacter pylori (H. pylori) infection which neutralizes and decreases secretion of gastric acid to aid its survival in the stomach.
  • A symptom of pernicious anemia, atrophic gastritis or of stomach cancer.
  • Radiation therapy involving the stomach.
  • Gastric bypass procedures such a Duodenal Switch and RNY, where the largest acid producing parts of the stomach are either removed, or blinded.
  • VIPomas and somatostatinomas are both islet cell tumors of the pancreas.
  • Pellagra, caused by niacin deficiency.
Little is known on the prognosis of achlorhydria, although there have been reports of an increased risk of gastric cancer. 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. Furthermore, experiments with achlorhydric mice have shown that non-Helicobacter bacteria can induce atrophic gastritis, which, in turn, can cause gastric carcinoma.achlorhydriaSymptoms:Achlorhydria can result as known complications of bacterial overgrowth, intestinal metaplasia, and hip fracture. Therefore, a history of abdominal discomfort, early satiety, weight loss, bowel movement frequency, reflux symptoms, and abdominal bloating should be takenbacterial overgrowth can cause micronutrient deficiencies that result in various clinical neurological manifestations. A complete neurological history, including history of visual changes, paresthesias, ataxia, limb weakness, gait disturbance, memory defects, hallucinations, and personality and mood changes, should also be obtained.Diagnosis:While not all patients with suspected achlorhydria need documentary evidence of a lack of acid production, the most important study to prove the presence of the condition is measurement of basal acid secretion.For practical purposes, gastric pH at endoscopy should be done in patients with suspected achlorhydria. Older testing methods using fluid aspiration through a nasogastric tube can be done. These procedures can cause significant patient discomfort and are less efficient in obtaining a diagnosis. It has been proposed that fasting gastric pH can be predicted non-invasively using an equation based on the serum pepsinogen I level and the presence/absence of H pylori.A complete profile of gastric acid secretion is best obtained during a 24-hour gastric pH study.
  • Achlorhydria may also be documented by measurements of extremely low serum levels of pepsinogen A (PgA) (< 17 mcg/L).
  • High serum gastrin levels (>500-1000 pg/mL) may support a diagnosis of achlorhydria.
  • Litmus paper is readily available to examine the pH of gastric secretions and, in contrast to the pH electrode, is less expensive while providing equally reliable results.
Treatment:Treatment focuses on addressing the underlying cause of symptoms. With Helicobacter pylori induced achlorhydria, antibiotic treatment is usually prescribed, though it may not always reverse the condition completely.NOTE: The above information is educational purpose. The information provided herein should not be used during any medical emergency or for the diagnosis or treatment of any medical condition.DISCLAIMER: This information should not substitute for seeking responsible, professional medical care.

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