Overview and Treatment of Achlorhydria

Achlorhydria (Pronounced: AY-klor-HY-dree-uh) is an absence of hydrochloric acid in stomach juice. 

Hydrochloric acid helps maintain the pH levels in the gastric juices so that the enzymes that help break down food into digestible and absorbable substances can do their job. It also helps maintain just the right acidic environment to keep disease and infection away.

If you suffer from GERD or heartburn, achlorhydria should be a concern because using H2 blockers or proton pump inhibitors (PPIs) can be a precursor to this condition. Taking these medications are not the only way that achlorhydria can occur. Other causes include:

• autoimmune disorders, such as Sjögren's syndrome, diabetes, and thyroid disease
• Helicobacter pylori (H. pylori) infection
• pernicious anemia
• radiation therapy involving the stomach
• or gastric bypass procedures where the largest acid producing parts of the stomach are either removed or bound

Because of the nature of the condition, nutritional deficiencies can occur and may offer your physician clues that lead to an achlorhydria diagnosis. Specifically, B12 and iron deficiencies have been linked to the condition. When they paired with a history of abdominal discomfort, weight loss, frequent bowel movements, reflux symptoms, and abdominal bloating, your doctor may then decide to test the pH of your stomach.

Whether you are diagnosed with achlorhydria is determined by your results and if they show:

• a pH in the stomach greater than 5.09 in men and greater than 6.81 in women
• a maximal acid output of less than 6.9 m/mole/h in men and less than 5.0 m/mole/h in women
• and a ratio of serum pepsinogen I/pepsinogen II of less than 2.9

As mentioned above, iron deficient anemia and B12 deficiencies can occur with achlorhydria. One complication that can arise because of these deficiencies is weak bones, which can result in fractures, especially of the hip.

Another complication is intestinal metaplasia, where the tissue of the stomach and the esophagus transform into tissue that is found in the intestine. This is known as a condition called Barrett's esophagus. 

Finally, because there isn't hydrochloric acid being produced in the stomach, bacterial overgrowth can occur. This overgrowth can lead to H. pylori infection, which can cause peptic ulcers, and it can cause micronutrient deficiencies that can lead to neurological problems, such as changes in vision, mood, personality, and gait; weakness in arms and legs; tingling or numbness in the toes and fingers; hallucinations; and loss of memory and control of bodily movements. 

The cause of your achlorhydria will determine your treatment path. For instance, if chronic use of PPIs were how you developed this condition, the first step your doctor may take is to stop having you take these medications, and possibly H2 blockers as well. If an autoimmune disorder is to blame, steps could be taken to get that condition in line. Basically, there is not one set treatment option, but your doctor will know what treatments fit with your version of achlorhydria.