Hypochlorhydria
Dr. Weyrich's Naturopathic Functional Medicine Notebook
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Overview
Hypochlorhydria is a condition of the stomach in which the amount of digestive juices (hydrochloric acid) is reduced. This can lead to poor digestion of proteins, as well as other gastrointestinal disturbances. If untreated, chronic hypochlorhydria can lead to Helicobacter pylori infection, malnutrition, and possibly autoimmune diseases.Signs and Symptoms
Symptoms often occur 30 minutes to an hour after eating a meal containing protein, and may include:- Gas, bloating, and belching.
- Feeling that food is sitting in the stomach like a rock.
- Heartburn (may also be caused by hyperchlorhydria).
Other signs and symptoms may be noticed over a longer period of time, including:
- Diarrhea or constipation.
- Adult acne (rosacea), dilated blood vessels in the nose and cheeks.
- Signs of protein malnutrition: hair loss and weak nails, muscle weakness.
- Anemia (iron or vitamin B-12 deficiency).
- Bad breath due to putrefacation of poorly digested protein.
Etiology
- Production of gastric juices normally declines with age.
- Drug-induced: proton pump inhibitors, histamine-2 receptor blockers, NSAIDs (aspirin, ibuprofen), acetaminophen, oral contraceptives.
- Chronic stress-induced sympathetic nervous state.
- Excessive carbohydrates (sugars) in diet.
- Inadequate protein in diet to stimulate production of stomach acid.
- Nutritional deficiencies: Zn, thiamine.
- Menopause: low estrogen levels.
- Autoimmune disease (pernicious anemia).
- Marijuana.
Differential Diagnosis
- It is important to distinguish hyperchlorhydria from hypochlorhydria, as they can both produce the symptom of heartburn, but the treatments are opposite.
- Heart attack (heart-burn and feeling of oppression).
- Chronic atrophic gastritis.
Sequelae
- Poor absorption of mineral nutrients (Ca, Fe).
- Poor absorption of proteins.
- Decreased immune function (HCl kills many bacteria), leading to increased susceptibility to Helicobacter pylori and gut dysbiosis.
- Increased risk of food sensitivities, possibly provoking autoimmune diseases.
Pathophysiology
Adequate levels of stomach acid are required to close both the esophageal and pyloric sphincters. If the esophageal sphincter does not close tightly, gastro-esophageal reflux (GERD) may occur as gastric juices pass up the throat. If the pyloric sphincter does not close tightly, basic digestive juices from the duodenum may pass up into the stomach, irritating the gastric lining.Acidic solution is required to absorb minerals such as iron and calcium. Chronic hypochlorhydria may result in inadequate absorption of these important minerals.
Acid from the stomach is needed to stimulate the release of pancreatic digestive fluids into the duodenum. Insufficient acid may result in pancreatic deficiency as well.
Acid in stomach forms a physical barrier to many bacteria, including Helicobacter pylori. Inadequate stomach acid predisposes the patient to a variety of gastrointestinal infections and dysbiosis.
Hydrochloric acid is generated by the same cells in the stomach that release "intrinsic factor", which is required for the absorption of vitamin B-12 in the intestine. Reduced HCl production leads to a concomitant reduction in intrinsic factor, which can lead to anemia.
ICD-9 Codes
| ICD9-Code | Description | Comments |
|---|---|---|
| 537.9 | Unspecified stomach disorder |
References
Unless specifically noted above, references used in the construction of this web page include the following:[FDM] Lecture notes from Functional Medicine University.
[SCNM] Lecture notes from Southwest College of Naturopathic Medicine.
[UT] Lecture notes from the University of Tennessee graduate programs in Chemistry and Biochemistry.
Copyright © 2007-2010 Dr. Weyrich (Naturopathic Medical license number 07-1008). The information on this site is for educational purposes only. It is not intended to diagnose, treat or cure any disease or illness. The statements on this website have not been evaluated by the Food and Drug Administration.
This web page is http://www.DrWeyrich.com/disorders/hypochlorhydria.html - Phone Dr. Weyrich at (480) 423-6952