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Understanding Hypochlorhydria With Gastroenterologist Dr Gwee Kok Ann

Understanding Hypochlorhydria With Gastroenterologist Dr Gwee Kok Ann

Hypochlorhydria refers to a condition where there’s a reduction in the production of hydrochloric acid in the stomach. Hydrochloric acid is essential for various digestive processes, including the digestion of food and the absorption of nutrients.

Hypochlorhydria‘s prevalence among the Asian population is estimated at 68 out of every 10,000 people. Medical Channel Asia interviews Gastroenterologist Dr Gwee Kok Ann to understand this condition better. Dr Gwee is a Consultant Gastroenterologist at Gleneagles Hospital, Founding President of Irritable Bowel Syndrome Support Group and Adjunct Associate Professor of Medicine at National University of Singapore.

Can you explain what hypochlorhydria is and what are the common causes of this condition? How does it differ from achlorhydria?

Both hypochlorhydria and achlorhydria refer to a state of reduced acid production in the stomach but to different degrees of severity. Hypochlorhydria implies a partial reduction of gastric acid secretion, while achlorhydria represents the extreme end of the scale and implies the total absence of gastric acid production. In practice, both terms are frequently used interchangeably as the underlying cause, and the adverse effects of the two are similar.

Here are common reasons for reduced gastric acid production:

  1. Taking acid-suppressing medications, especially proton pump inhibitors (PPIs). Omeprazole ranks among the world’s most used drugs. This is a common drug that gets prescribed and many patients take it for a very long time.
  2. Infections from Helicobacter pylori in the stomach often become chronic. Typically, individuals contract it in childhood. Over time, if the infection intensifies, the bacteria can harm the stomach’s acid-producing cells.
  3. Pernicious anaemia is an autoimmune condition. In this condition, the body produces antibodies that attack the stomach’s acid-producing cells.

Are there any potential complications or associated conditions arising from hypochlorhydria if left untreated? How do these impact the long-term health of the patient?

Hypochlorhydria impairs the absorption of many vitamins and micronutrients, especially affecting iron, vitamin B12 and calcium.

Hypochlorhydria increases the risk of intestinal infections such as food poisoning with salmonella, campylobacter, shigella, cholera and E. coli.  A particularly dangerous infection is Clostridium difficile which is very difficult to treat; this condition can cause severe colon inflammation, giving rise to diarrhoea, bleeding in the intestine and malnutrition.

Hypochlorhydria predisposes to increased amounts of bacteria in the small intestine. This can further aggravate the malabsorption of nutrients and the development of diarrhoea, bloating and flatulence. This condition is known as small intestinal bacteria overgrowth; patients with diabetes are at greater risk.

Hypochlorhydria increases the risk of lung infections in the elderly and in patients with diabetes, liver cirrhosis, dementia, and stroke.

Also, Hypochlorhydria may affect the absorption of drugs, including some cancer treatment drugs.

What are the typical symptoms of hypochlorhydria, and how is it diagnosed? Are there any particular signs or symptoms that may distinguish it from other gastrointestinal issues?

The symptoms of hypochlorhydria represent the manifestations of complications arising from hypochlorhydria.

In particular, hypochlorhydria can cause

  1. Iron deficiency manifesting as fatigue, breathlessness, reduced stamina
  2. Vitamin B12 deficiency manifesting as mood changes, aggravating dementia, mouth ulcers, sore tongue, unstable gait, pins and needles
  3. Bacterial overgrowth manifesting as bloating, flatulence, changes in bowel habits

What are the current treatment options for hypochlorhydria? Can you describe the role of dietary changes, medications, or other therapies in managing this condition?

Treatment with antibiotics may improve the absorption of vitamin B12 in some patients, especially those with Helicobacter pylori infection of the stomach.

Firstly, for individuals who are at risk, avoid taking acid-suppressing medications like omeprazole. Proton pump inhibitors are their name. An example is a very commonly prescribed drug known as omeprazole.

Additionally, avoid substances that may cause further damage to stomach cells; e.g., salt, vinegar, and preservatives. Also, encourage them to eat foods cooked with fresh ingredients and avoid preserved, salted, pickled foods.

Finally, avoid taking medications that can damage stomach cells; e.g., aspirin and NSAID (e.g. ibuprofen).

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