Generality
Hypochlorhydria is the reduction of the secretory activity of the stomach, with particular reference to the low production of hydrochloric acid. When this deficit turns into a total absence of acid inside the gastric juice, we speak of achlorhydria instead.
Gatrici juices
The acid secretion of the stomach represents an excellent defense against germs introduced with food, participates in the digestion of proteins and foods in general, and also facilitates the absorption of divalent and trivalent cations (calcium, zinc, copper, iron, magnesium , selenium, boron) in the intestine.
An "optimal secretory activity is also important to ensure adequate gastric emptying; paradoxically, therefore, people affected by hypochlorhydria can complain of gastric acidity and gastroesophageal reflux, due to the long residence times of the chyme in the stomach.
Symptoms and Complications
As anticipated, the excessive permanence of the bolus inside the gastric sac causes dyspepsia, with symptoms similar to those caused by reflux disease (halitosis, regurgitation, retrosternal burning).
Failure to activate pepsinogen to pepsin negatively affects the digestion of proteins, overloading the intestinal digestive systems. At this level, not completely digested proteins and other nutrients escape absorption, causing bloating, flatulence, malabsorption and diarrhea. The latter can be further aggravated by the proliferation of germs that have survived the poor antiseptic activity of hydrochloric acid.
Furthermore, achlorhydria can be accompanied by a lack of secretion of intrinsic factor, with consequent pernicious anemia (from vitamin B12 deficiency). A form of iron deficiency anemia is also possible, due to the reduced absorption of dietary iron. relation to a higher incidence of asthma, gallstones and food allergies, probably due to the lack of gastric digestion of potential protein allergens.
Causes
Stomach acid secretion is physiologically reduced with aging, so much so that hypochlorhydria affects up to 15% of people over the age of 65. However, hypochlorhydria and achlorhydria are also recorded during youth, for the most varied causes. At the origin of the problem may exist autoimmune disorders, for which the organism produces antibodies against the cells responsible for the production of hydrochloric acid. Hypochlorhydria can also have iatrogenic origins, ie due to the intake of antacid drugs, such as proton pump inhibitors or H2 antagonists. Even concentrated radiation therapy at the gastric level can damage parietal cells causing achlorhydria. Finally, surgical interventions such as gastric bypasses or stomach resections represent an "additional and possible cause of disease.
Hypochlorhydria is a common symptom of various diseases, such as pernicious anemia, atrophic gastritis and stomach cancer.
Diagnosis
High levels of gastrin in the blood are normally recorded in patients suffering from hypochlorhydria; this hormone is secreted in order to increase the acid secretion of the stomach and promote digestion. Like most hormones, gastrin is also subject to a feed-back mechanism, so when the gastric acidity decreases, it consequently increases the its release, and vice versa. The synthetic form of this hormone can be administered by the physician to diagnose hypochlorhydria, which is positive when the gastric pH remains high (> 4.0) despite the stimulatory effect of the hormone.
Treatment of hypochlorhydria depends on the origins of the disorder and its evolution.
Treatment
Symptomatic treatment can use the oral administration, during meals, of diluted hydrochloric acid, or digestive preparations that stimulate the natural production of acid by the stomach. Betaine HCl, pepsin, aperitif extracts (such as those of cinchona, artichoke or gentian), bromelain, papain and pancreatin (mixture of pancreatic enzymes such as amylase, lipase and trypsin) are among the most common ingredients of dietary supplements dedicated to the treatment of hypochlorhydria .
As for the diet - often integrated with mineral salts and vitamins (in particular B12) - particular attention is paid to the freshness and healthiness of the food, potential vehicles for food poisoning (such as mayonnaise, eggs, meat and shellfish. ), which should be consumed if possible after generous cooking (in particular minced meat). Antibiotics and antifungals may be necessary to eradicate the recurrent microbial infections caused by hypochlorhydria.
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