Achlorhydria is the absence of free hydrochloric acid in the stomach cavity due to a violation of its production by lining cells. It is manifested by a feeling of bursting and heaviness in the stomach, pain in the epigastrium, nausea, belching, bloating. A diagnosis can be made when performing EGD with congo-mouth staining, gastric biopsy and pH-metry; a study for the presence of helicobacteria, antibodies to gastric lining cells is necessarily performed. Specific treatment has not been developed enough, mainly exogenous hydrochloric acid and symptomatic treatment, physiotherapy are used.
K31.8 Other specified diseases of the stomach and duodenum
Achlorhydria is the process of reducing or completely stopping the production of hydrochloric acid in the stomach. According to the studies of this pathology, the vast majority of patients face it in old age. So, about 20% of the subjects were aged 50-60 years, 70% were over 80 years old. It is believed that this is due to more frequent infection with helicobacter infection in older age, increased frequency of stomach diseases in the elderly.
In the initial stages, when the underlying pathology is cured, it is possible to restore secretion. In the later stages, the prognosis is unfavorable. The development of achlorhydria in elderly patients is often associated with stomach cancer. Despite the efforts being made to study this pathology, effective treatment methods have not yet been identified. To date, it is possible to maintain the acidity of the stomach at a sufficient level only with replacement therapy.
According to research in the field of modern gastroenterology, the cause of the disease can be a variety of background diseases of the stomach and other organs. Most often, mucosal atrophy as a result of severe and prolonged helicobacter infection, autoimmune gastritis leads to a decrease in gastric acidity, while antibodies affect the stomach’s own cells, uremia in renal failure and age–related changes. Also, a decrease in the acid-forming function of the stomach can cause stress and endocrine diseases (autoimmune thyroiditis, diabetes mellitus, autoimmune polyglandular syndrome).
At the beginning of achlorhydria, a decrease in acid production may be due to functional reasons. The acidity of the stomach is determined by two mutually occurring processes: the production of HCl in the gastric mucosa and the production of mucus with bicarbonates. These two substances balance each other, with the predominance of free hydrochloric acid usually noted. If, for various reasons, the influence of mucus and bicarbonates begins to increase, the amount of free hydrochloric acid in the stomach cavity decreases, sometimes to zero, even with slightly reduced production.
If the cause of the development of this pathology is eliminated before the appearance of organic changes, the disease can be completely cured. With an organic lesion of the gastric mucosa, the cells of the stomach stop producing hydrochloric acid and completely atrophy, in this situation, even the elimination of the cause will not lead to the restoration of gastric secretion.
Even in the complete absence of hydrochloric acid in the stomach, the disease may not manifest itself with pronounced symptoms, and therefore the patient may not be aware of it for a long time. In this situation, irreversible changes in the gastric mucosa may develop even before the start of treatment. Sometimes significantly reduced acidity is accidentally detected during examinations for another pathology. Fortunately, in most cases, achlorhydria is manifested by symptoms of stomach damage, which allow for diagnosis and correct diagnosis in the early stages of the disease.
Patients are usually disturbed by a feeling of bursting and heaviness in the stomach after eating, dull aching pains in the epigastrium. Nausea, belching and bloating may occur. These symptoms are caused by a violation of the digestion of food, especially protein, with a decrease in the amount of hydrochloric acid in the stomach.
There are several research methods for detecting achlorhydria. The most accurate method is EGD (gastroscopy) with simultaneous pH–metry and endoscopic mucosal biopsy. Assessment of the content of free hydrochloric acid in gastric juice will allow you to determine the acidity of the stomach. A biopsy examination will reveal mucosal atrophy or destruction of acid-producing cells. Also, Helicobacteria can be found in the biopsy, which can cause severe chronic gastritis. During gastroscopy, it is possible to stain the mucosa with congo-mouth dye – this diagnostic method will allow you to evaluate the acid-forming function of stomach cells.
A blood test is taken for the content of specific hormones – pepsinogens and gastrin. With atrophy of the gastric mucosa, the amount of gastrin in the blood increases, and pepsinogens decreases. Also, the presence of antibodies to stomach cells is determined in the blood, and PCR diagnostics of Helicobacter pylori is performed.
Achlorhydria can be combined with various diseases of the stomach. So, with pernicious anemia, antibodies to the stomach’s own lining cells circulate in the blood, which can provoke the development of achlorhydria. If a significantly reduced amount of hydrochloric acid is detected in the stomach, the patient should be excluded from chronic gastritis (helicobacter, atrophic, autoimmune), as well as stomach cancer.
Pathology is usually treated by a gastroenterologist in close cooperation with endoscopists, therapists and physiotherapists. Unfortunately, at the moment, methods for a complete cure of this condition have not yet been developed. Usually, therapy is reduced to the replacement of reduced gastric function, symptomatic treatment.
First of all, when the acidity of the stomach decreases, a special diet is prescribed: the food should be semi-liquid and warm, it should be taken often and in small portions. In the acute phase of the disease, table 1a is prescribed, when the condition improves, they switch to table 2, then to a full-fledged fortified diet. Foods that stimulate gastric secretion should be included in the diet: sour juices (lemon, cranberry, cabbage, tomato), weak coffee, cocoa, herbs and vegetable broths. Decoctions of herbs will also be useful: wormwood, dandelion root, fennel, parsley, plantain.
Achlorhydria replacement therapy involves taking natural gastric juice during meals. A tablespoon of juice is dissolved in half a glass of water, drink the solution in small sips during meals. Combined enzyme preparations are also prescribed. A drug based on cattle blood hemodialysate, nandrolone decanoate, carnitine, sea buckthorn oil helps to restore the gastric mucosa and its function well. In severe autoimmune gastritis, corticosteroid hormones can be used.
After the end of treatment in the gastroenterology department, it is recommended to conduct sanatorium treatment using therapeutic mineral waters. In the treatment and prevention of achlorhydria, bicarbonate, sodium chloride waters are used.
Prognosis and prevention
The prognosis of achlorhydria is favorable with timely diagnosis and the beginning of treatment. To a high degree, it depends on the background pathology that caused achlorhydria. Functional lesions respond to treatment better, and organic changes in the mucosa most often determine the irreversible nature of the disease. Prevention of achlorhydria consists in timely detection of diseases that can lead to this pathology, since early initiation of treatment of chronic gastritis and other conditions reduces the likelihood of irreversible damage to stomach cells.