What is Achlorhydria? Low Stomach Acid or No Gastric Acid

What causes low stomach acid?
What are the symptoms of achlorhydria?
How is achlorhydria treated?

Achlorhydria and hypochlorhydria are medical terms for low or very low volumes or a higher than normal pH of gastric acid.

Achlorhydria may refer to:

a problem with the pH of gastric acid. In this case the pH of the gastric acid is too high resulting in it being less acidic or rarely, even slightly alkaline.
a lower than normal volume of the gastric acid.
a lower than normal ratio of pepsinogen conversion, a digestive enzyme in the stomach that is eventually converted to pepsin by the gastric acid.

What causes low stomach acid?

Caused of Hypochlorhydria/Achlorhydria

Hydrochloric acid (HCl) is an important component of digestion. It is secreted by the parietal cells of the gastric lining and acts with other enzymes like pepsin in chemically digesting food. If the secretion of HCl is affected then the normal digestion of foods may be impaired. HCl also plays an important role in converting pepsinogen into pepsin. Even the active form, pepsin, requires an acidic environment to function appropriately. Without pepsin, the breakdown of protein in the stomach is impaired.

Some of the causes of achlorhydria includes :

Helicobacter pylori infection of the stomach as the bacteria neutralizes gastric acid and reduces acid secretion.
Stomach cancer, particularly a malignant tumor affecting the parts of the stomach where most of the stomach acid is secreted. A VIPoma which is a tumor of the pancreas may also result in achlorhydria.
Long term and excessive use of proton-pump inhibitors (PPI) which is used to reduce gastric acid secretion in cases of gastroesophageal reflux disease (GERD/acid reflux).
Autoimmune causes where antibodies target the parietal cells of the stomach impairing HCl production.
Small bowel bacterial overgrowth affects the normal intestinal flora and allows other pathogenic microorganism to thrive in the stomach and small intestine.
Gastric resection or gastric bypass surgery.
Radiation therapy of the stomach.

It is rare for there to be a total cessation of gastric acid secretion (no acid/absent gastric acid). In most cases of achlorhydria, the quantity or pH of gastric acid is so severely impaired that it renders the acid incapable of acting upon food as is normally expected.

What are the symptoms of achlorhydria?

Signs and Symptoms of Low Gastric Acid

There are no specific signs and symptoms associated with achloryhydria and most of the clinical features noted are as a consequence of impaired digestion. Other signs and symptom can be attributed to the various causes of low stomach acid and not due to achlorhydria itself.

However, the impaired digestive function due to the lack of or ineffective gastric acid may be noticed. Malabsorption syndromes may arise which will be evident by various vitamin and mineral deficiencies. This may be evident in the neurological complications associated with malabsorption like numbness, tingling or burning sensation of the limbs, impaired senses (like vision) and anemia.

Gastric acid plays an important role in destroying microorganisms that enter the gastrointestinal tract (gut). Without this protection, various gastrointestinal infections may arise and there may be recurrent bouts of infectious gastroenteritis leading to vomiting and diarrhea.

How is achlorhydria treated?

Treatment of Achlorhydria

The treatment for low gastric acid is dependent on the cause of achlorhydria.

In the case of achlorhydria due to H.pylori infection, antibiotics and a proton-pump inhibitor (PPI) may be necessary. This should be continued for 14 days or more to eradicate the bacteria from the stomach and duodenum. Repeat courses may be necessary.

Achlorhydria that is caused by caused by tumors (stomach cancer) needs a combination of surgical resection as well as chemotherapy and/or radiation therapy. However, these treatment modalities may also cause achlorhydria.

Low doses of corticosteroids may help to reduce the inflammation of the parietal cells as a result of autoimmune causes. This may be useful in achlorhydria with accompanying eosinophilic gastroenteritis.

Nutritional supplementation, especially vitamin B12 and thiamine, may be necessary for treating vitamin deficiencies as well as treating certain conditions like pernicious anemia that may be responsible for achlorhydria.


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