Hypochlorhydria - Causes, Symptoms, Diagnosis, and Treatment

Introduction

Stomach secretion consists of enzymes, a coating of a mucous layer that protects the stomach's lining, and stomach acid called hydrochloric acid. Hydrochloric acid is essential for breaking down, digesting, and absorbing nutrients like protein. It also helps in the elimination of bacteria and viruses present in the stomach, thereby protecting the body from infections.

What Is Hypochlorhydria?

Hypochlorhydria is a deficiency of a stomach acid called hydrochloric acid. A deficiency in hydrochloric acid affects the body's capability to digest and absorb nutrients. This deficiency causes malnutrition, indigestion, and, at times, an overgrowth of bacteria. If the condition is left untreated, low levels of hydrochloric acid cause nutritional deficiencies, infections, damage to the gastrointestinal system, and various other health issues.

How Is Hypochlorhydria Caused?

Some of the causes of hypochlorhydria include the following:

• Advanced Age - As age progresses, the chances of hypochlorhydria increase. People over the age of 65 mostly have low stomach acid levels.

• Stress - Chronic stress can reduce stomach acid production. Stress does not mean everyday stress; it means that if a person has significant stress over a very long period, it tends to affect the production of stomach acid.

• Vitamin Deficiency - Vitamin B or zinc deficiency can lead to low stomach acid levels. These deficiencies, usually happen due to inadequate dietary intake or loss of nutrients due to smoking, consumption of alcohol, or stress.

• Medications - Consumption of medications over a longer period, like antacids or those prescribed to manage acid reflux and ulcers, can lead to low levels of stomach acids.

• Helicobacter Pylori Infection - The most commonly seen bacterial infection in the stomach is the H. pylori infection. For some people, H. pylori can decrease the levels of stomach acids, whereas, in some cases, low levels of stomach acids can cause an H. pylori infection.

• Atrophic Gastritis - In this condition, the cells that secret the stomach acids deteriorate and stop working, causing stomach inflammation. It can be caused due to various reasons like alcoholism, autoimmune diseases, and bacterial infection like H. pylori infection.

• Surgery - Surgery like gastric bypass surgery tends to affect the production of stomach acids.

How Does Hypochlorhydria Affect the Body?

Stomach acids like hydrochloric acid are needed to digest and absorb nutrients like proteins, vitamin B12, and several other minerals. When a deficiency in stomach acid happens, the body faces difficulty breaking down these nutrients, and the person ends up with nutrition deficiency and undigested food. When undigested food forms in the gastrointestinal tract, it causes various short-term symptoms; if left untreated, it can lead to serious long-term problems. In addition, low levels of stomach acid and undigested food increase the chances of overgrowth of bacteria like Helicobacter pylori, which is associated with peptic ulcer disease and gastritis. Furthermore, vitamin deficiency anemia and iron deficiency anemia caused due to vitamin B12, protein deficiency affects the nervous system, and magnesium and calcium deficiencies can lead to osteoporosis.

What Are the Symptoms Associated With Hypochlorhydria?

Symptoms of hypochlorhydria include excessive burping, bloating, heartburn, gas, an upset stomach, nausea while taking vitamin supplements, diarrhea, constipation, acid reflux, indigestion, brittle fingernails, hair loss, less energy, presence of undigested food in stools, iron deficiency anemia, protein deficiency, magnesium, vitamin B12, calcium deficiency, neurological symptoms like memory loss, tingling, numbness, and vision changes.

What Are the Risk Factors Associated With Hypochlorhydria?

Risk Factors Associated With hypochlorhydria include the following:

• Increased stress levels.

• Being above 65 years of age.

• Vitamin deficiency.

• H. pylori infection.

• Medications that reduce stomach acid.

• A history of stomach surgery.

How Is Hypochlorhydria Diagnosed?

The healthcare practitioner will ask about the symptoms, take a detailed medical history and perform a physical examination. To confirm hypochlorhydria, a few other stomach acid tests are also done.

• The Heidelberg pH Test - In this test, the patient must swallow a capsule containing a radio transmitter. This capsule can measure the pH levels in the stomach. A baseline measurement will be taken, after which the patient will be asked to drink a baking soda solution to neutralize the stomach acids. The test will be repeated to check how long the stomach acid takes to return to the baseline levels. This test difference shows how well the stomach produces and secretes its acids.

• The Smart Pill Test - This test also contains a wireless transmitter that has to be swallowed. But unlike the Heidelberg test, this test measures gastric acid levels instead of pH.

• The Gastric String Test - The patient will be asked to swallow a capsule attached to a string. After ten minutes of the test, the capsule will be pulled out using the string. The string is then tested with pH paper. Zero is the most acidic level on the scale, and normal stomach acid shows pH levels of one to two, which is highly acidic. If a patient has hypochlorhydria, the range of stomach acid will be from three to five. Five shows the condition of achlorhydria (no hydrochloric acid).

If a patient is diagnosed with hyperchlorhydria, the doctor will recommend additional tests to detect the presence of bacterial infections or nutritional deficiencies.

What Are the Treatment Options Available for Hypochlorhydria?

1. Management of hypochlorhydria depends on the underlying cause and the severity of its symptoms.

2. A hydrochloric acid (HCl) supplement called Betaine hydrochloride is given along with an enzyme called pepsin which will help increase the production of acids in the stomach. These supplements also help in the digestion process and will return the stomach acid to normal levels.

3. If the diagnosis of hypochlorhydria is unclear, hydrochloric supplements will help diagnose hyperchlorhydria.

4. If H. pylori is the causative factor, antibiotics are given to treat the bacterial infection.

5. If medications are causing low levels, the doctor would change the medication and suggest an appropriate course of treatment for the patient.

6. Nutritional deficiencies are managed with vitamin B12, calcium, or iron supplements.

7. Dietary modifications and supplements are also recommended for its management.

Are There Any Diet Recommendations for Hypochlorhydria?

Some dietary recommendations for hypochlorhydria include:

• Eating protein at the beginning of every meal will help stimulate acid production.

• Include probiotic foods like yogurt, which will help boost the good stomach bacteria and keep the harmful bacteria aside.

• Chew thoroughly and eat smaller meals; this will help the digestive system to break down the food.

• Drink water only after 30 minutes after every meal. This time gap will give time for the stomach to produce enough acids and metabolize the proteins.

• Try eating the last meal of the day about two to three hours before bedtime. This gap will give enough time for the body to digest the food.

• Avoid processed and fatty foods, which are difficult to digest and have very little nutritional levels.

• Minerals like protein, calcium ions, and vitamin B12 are mostly present in animal-sourced foods like fish, meat, and dairy products. Vegetarians need to take supplements to meet their nutritional levels.

Conclusion

Hypochlorhydria is the presence of low levels of stomach acids in the body. Symptoms include heartburn, acid reflux, abdominal pain, bloating, constipation, or diarrhea. It can be caused due to various factors like stress, old age, bacterial infections, or intake of medications that reduce stomach acids. It is important to identify the underlying causative factor to manage the condition. Hypochlorhydria can be reversed and successfully treated with hydrochloric acid supplements.