Signs and Symptoms of Hypochlorhydria
- 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 putrefaction of poorly digested protein.
Etiology of Hypochlorhydria
- 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).
Differential Diagnosis of Hypochlorhydria
- 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 of Hypochlorhydria
- 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 of Hypochlorhydria
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 related to Hypochlorhydria
ICD9-Code Description Comments
537.9 Unspecified stomach disorder
|537.9||Unspecified stomach disorder|