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Achlorhydria



What is Achlorhydria?

Achlorhydria is the absence or reduced secretion of hydrochloric acid in the stomach which can arise due to several underlying disease conditions, the most serious of which is stomach cancer.


Achlorhydria can occur in men and women of all ages, races and ethnic groups. Older people are especially susceptible to this condition.

Prevalence of Achlorhydria

Data on the prevalence of achlorhydria in the Indian population is very scanty. With reference to pernicious anemia, resulting from malabsorption of vitamin B12 the prevalence of achlorhydria is 5-10% on the Schilling test.

Anatomy & Physiology of the Stomach in Brief

The stomach is a muscular digestive organ located on the left side of the upper abdomen. It receives food from the esophagus or food pipe that enters through the esophageal sphincter. The stomach wall consists of three layers of muscles (longitudinal, circular and oblique) that help to mix the food with the gastric juices, consisting of hydrochloric acid and digestive enzymes that help to digest the food. The inner side of the stomach is folded into muscular ridges called rugae that help to churn the food and convert it into a paste like consistency known as chyme. This chyme passes into the next part of the digestive tract called the duodenum for further digestion. The flow of chyme is regulated by the pyloric sphincter, located at the junction of the stomach and duodenum.

What are the Causes of Achlorhydria?

The major causes of achlorhydria include the following:

What are the Symptoms and Signs of Achlorhydria?

The major signs and symptoms of achlorhydria include the following:

What are the Risk Factors for Achlorhydria?

Some of the risk-factors of achlorhydria also overlap with its causes. Some of the major risk-factors include the following:

How do you Diagnose Achlorhydria?

Diagnosis of achlorhydria can be made in a step-by-step manner, as highlighted below:

Medical History: A thorough medical history of the patient will help to identify pre-existing conditions that could facilitate the diagnosis. History of chronic PPI use, chronic H. pylori infection, prior gastric bypass surgery and autoimmune diseases would point towards achlorhydria.


Routine Tests: The following tests are usually ordered if the doctor suspects achlorhydria:

Specialized Tests: Some of the specialized tests that help to identify the underlying cause of achlorhydria are useful for initiating treatment measures. Some of these tests are briefly highlighted below:


How do you Treat Achlorhydria?

The treatment modality depends on the cause of achlorhydria. Some of these treatment strategies are briefly highlighted below:

How do you Prevent Achlorhydria?

There are very few preventive strategies for achlorhydria. There is no primary preventive strategy. A couple of secondary preventive strategies do exist, although their usefulness and efficacy remain doubtful.

References:

  1. Roux-en-Y gastric bypass weight-loss surgery. - (https://www.hopkinsmedicine.org/healthlibrary/test_procedures/gastroenterology/roux-en-y_gastric_bypass_weight- loss_surgery_135,65)
  2. Gastric carcinoids: The American Association of Endocrine Surgeons. - (http://endocrinediseases.org/neuroendocrine/gastric_carcinoid.shtml)
  3. Gastric acid secretion test: National Cancer Institute, USA. NCI Dictionary of Cancer Terms - (https://www.cancer.gov/publications/dictionaries/cancer-terms?cdrid=657844)
  4. Gray GR, Gillespie G, Gordon I. Extragastric gastrinoma or G-cell hyperplasia of the antrum? The preoperative diagnosis in a case of hypergastrinaemia. Br J Surg. 1976 Aug; 63(8): 596-8. PMID: 953461
  5. Sachdev AH, Pimentel M. Gastrointestinal bacterial overgrowth: pathogenesis and clinical significance. Ther Adv Chronic Dis. 2013 Sep; 4(5): 223�231. doi: 10.1177/2040622313496126

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