Title: Hypochlorhydria

Key words: pernicious anaemia, pepsin, vitamin B12, gastric acid, investigations, treatment

Date: Oct 2000

Category: 8. The Gut

Type: Article

Author: Dr C Forsyth

 

 

Hypochlorhydria

Hypochlorhydria is very common and yet is almost totally ignored by mainstream medicine at present. We all learn about it as medical students, and yet when was the last time you heard of any patient being investigated for hypochlorhydria?  We know that it is present in pernicious anaemia, but when did we ever prescribe HC1 and pepsin along with vitamin B12?

 

Gastric acid secretion decreases with age - more than half the over 60's are hypochlorhydric.  In my practice, of the 270 patients I tested in an eight-year period, 47% had some degree of hypochlorhydria.

 

Gastric acid is necessary for:

·       Pepsin activation

·       First stages of protein digestion

·       Mineral absorption

·       Activating pancreatic proenzymes

·       Maintaining normal gastrointestinal microflora

 

Production of acid, pepsin and intrinsic factor probably all vary together most of the time.

 

Common Signs & Symptoms of Hypochlorhydria

Symptoms that one normally associates with hyperchlorhydria may often equally well be due to hypochlorhydria.

 

·       Bloating, belching, burning, flatulence - immediately after meals

·       A sense of fullness after eating

·       Indigestion, diarrhoea, constipation

·       Systemic reactions after eating

·       Nausea after taking supplements

·       Rectal itching

·       Weak, peeling or cracked fingernails

·       Dilated capillaries in the cheeks & nose (in non-alcoholics)

·       Post-adolescent acne

·       Iron deficiency

·       Chronic intestinal infections- parasites, yeasts, bacteria

·       Undigested food in the stool

 

 

Diseases and Conditions that may be associated with Hypochlorhydria

 

·       Addison's disease

·       Ageing

·       Asthma

·       Autoimmune disorders, incl. rheumatoid arthritis

·       Chronic intestinal infections - bacterial, parasitic, etc.

·       Coeliac disease

·       Dermatitis herpetiformis

·       Diabetes mellitus

·       Dysbiosis - bacterial or yeast

·       Eczema

·       Food intolerances

 

·       Gall bladder disease

·       Gastric carcinoma

·       Gastritis

·       Hepatitis

·       Hyperthyroidism

·       Hypothyroidism

·       Lupus erythematosis

·       Osteoporosis

·       Pernicious anaemia

·       Psoriasis

·       Rosacea

·       Urticaria

·       Vitiligo

 

 

 

Investigations:

·       Gastrogram (non-invasive - uses a swallowed transducer capsule which measures pH and lipase activity) - Biolab

 

Treatment:

·       Identification and treatment of predisposing factors and secondary effects

·       HCl and pepsin

·       Vitamin B12 injections where necessary