Dr. Weyrich's Naturopathic Functional Medicine Notebook is a collection of information on topics of interest to Dr. Weyrich that may be of interest to the world wide audience. Due to limitations of time, not all information that Dr. Weyrich knows or would like to further research is published here. Dr. Weyrich welcomes financial contributions to support specific research topics, as well as copies of non-free access journal articles for him to review on a topic. Constructive criticism is also welcome.


Overview of Hypochlorhydria

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 of Hypochlorhydria

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 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).
  • Marijuana.

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

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 related to Hypochlorhydria

ICD9-CodeDescriptionComments
537.9Unspecified stomach disorder 

References for Hypochlorhydria