Achlorhydria or Hypochlorhydria

WHAT IS ACHLORHYDRIA OR HPOCHLORHDRIA?

Achlorhydria or hypochlorhydria is a condition where stomach and other digestive organs stops or has reduced secretion respectively of hydrochloric acid

CAUSES OF HYPOCHLORHYDRIA/ACHLORHYDRIA

It usually is secondary to a primary condition like  bacterial overgrowth like helicobacter pylori etc which neutralizes HCl ; Gastro-intestinal Metaplasia ; Atrophic Gastristis ; Reducing Basal Metabolic Rate (BMR); autoimmune conditions where there are autoantibodies formed against gastric parietal cells that produces Gastric Acid ; frequent long-term use of antacids like H2 receptor antagonist or Proton pump inhibitors; mucolipidosis type IV, procedures like Gastric Bypass  Duodenal switch RNY ; Islet Cells tumors like  VIPomas ( Vasoactive intestinal peptides) and Somatostatinomas; Pellagra(niacin deficiency), Pernicious anemia, deficiency of mineral and electrolytes required to produce sufficient Gastric acid like sodium chloride potassium zinc iodine etc

So its a vicious cycle where pre-existing condition causes achlorhydria and achlorhydria further aggravates that primary cause.

SIGNS AND SYMPTOMS OF ACHLORHYDRIA OR HPOCHLORHDRIA

So along with symptoms of primary disease it will also show Gastro-Oesophageal Reflux Disease, anorexia, Early satiety while eating , weight loss, abdominal discomfort , sensation of fullness and distention of abdomen, frequent diarrhea and constipation, iron deficiency anemia due to lack of HCl ,pernicious nemia due to lack of Vit B12 and many other deficiencies like that of vitamin B complex ,vitamin k, vitamin C, and other micronutrients minerals like magnesium sodium chloride potassium zinc etc; causes many neuro-muscular disorders like general weakness esp. lower limbs with myalgia paraesthesia ataxia and gait disorders ;also psychological disorders like weak memory, mood disorders personality disorders, hallucinations etc. these patients are prone to infection of Vibrio Vulnificus and other usually uncommon infections of organisms found in food ( more commonly from seafood); all these complaints and many other collectively may prove fatal.

DIAGNOSISACHLORHYDRIA OR HPOCHLORHDRIA

  • Oesophageal pH monitoring giving 24-hour profile of gastric acid Secretion
  • Gastric pH at endoscopy
  • extreme low levels of pepsinogen A(PgA) < 17ug/l in blood serum and  high serum Gastrin Level >500-1000pg/ml supports the diagnosis
  • Heidelberg test is an alternate test
  • Many other tests like Serum iron , serum calcium, vit B12, Vit D, Thaimin, CBC tests for various forms of anemia elevation in serum folate level s/o small bowel bacterial growth etc  can help to exclude associated conditions
  • Once achlorhydria is confirmed a hydrogen breath test should be conducted to exclude bacterial overgrowth