In the Achlorhydrie the gastric juice of the patients contributes too little or no hydrochloric acid at all. As a consequence, the absorption of substances such as iron is disturbed and pernicious anemia occurs. The treatment consists of dietary steps and vitamin B12 substitution.

What is achlorhydria?

In the Achlorhydrie the gastric juice of the patients contributes too little or no hydrochloric acid at all.

The stomach acid supports the decomposition of food components within the stomach. It is an aqueous solution with about 0.5 percent hydrochloric acid. The porridge is prepared by gastric acid for further processing in the intestine. In achlorhydria, gastric acid is pathologically altered in its composition.

The aqueous solution contains no hydrochloric acid in the context of the disease. The underlying cause of the disease is impaired hydrochloric acid secretion by the parietal cells of the stomach. These cells are large glandular cells of the gastric mucosa, which occur within the fundus and the corpus ventriculi. The cells cleave protons from carbonic acid and secrete them on the apical side in exchange with potassium ions.

In addition, they serve to transport chloride ions, which they transport from their basal side through the cytosol and release into the gastric lumen. This produces the hydrochloric acid, which lowers the pH of the gastric juice. In most cases there is a complete loss of function of the gland cells in the context of an achlorhydria, especially in the case of absolute achlorhydria. In a relative or chemical achlorhydria the glandular cells fulfill their function and hydrochloric acid is only apparently absent.

causes

The cause of an achlorhydria is an actual or apparent loss of function of the parietal cells. Destruction of the glandular cells can occur, for example, in the context of autoimmune destruction, as in type A gastritis. In addition, gastric carcinomas in the area of ​​the gland cells can cause a loss of function of the glandular tissue.

Therapeutic interventions such as gastrectomy or proton pump inhibitor therapy may also result in functional impairments to the gastric glands. As a rule, in the context of achlorhydria based on the causes just mentioned, HCl and an absolute lack of intrinsic factor occur. The parietal cells are mainly stimulated by histamine for secretion.

The digestive tract is an independent functional system that itself produces stimuli to function. In the context of histamine, this means a vagal or gastro-induced histamine release by ECL cells, which are located on the gastric mucosa in close proximity to the glandular cells. For this reason, the system may also be disturbed in diseases of the histamine producers. Frequently, the Achlorhydrie is also in the context of WDHA syndrome.

Symptoms, complaints & signs

In addition to watery diarrhea, pernicious anemia or Biermer's disease is the most important symptom of achlorhydria. This type of anemia is due to a lack of vitamin B12. The intrinsic factor formation of patients is disturbed. The typical complaints of Biemer's disease are fatigue, decreased performance, increased heart rate, severe paleness and collapse tendency.

Also, jaundice with indigestion or abdominal pain may be present. In individual cases neurological symptoms can also develop, especially numbness and misperceptions in the form of skin tingling or furry feeling. In addition to sleepy hands and feet, gait insecurity, coordination disorders and even paralysis can occur as part of the disease.

These symptoms are often rounded off by psychological and cognitive symptoms such as poor memory, difficulty concentrating, depression or psychosis. The absorption of nutrients is subject to disorders in an achlorhydria. Gastric acid mainly promotes the absorption of iron, so that achlorhydria can cause iron deficiency. The severity and the symptoms may differ from case to case.

Diagnosis & History

Indications in the diagnosis of achlorhydria in addition to the typical symptom picture, especially the history of the underlying diseases. In laboratory diagnostics, achlorhydria presents as pernicious anemia and compensatory hypergastrinemia. Undoubtedly, the state of achlorhydria is detected by means of pH analysis of gastric juice, which we usually derive via a nasogastric tube.

As secretory stimulus, pentagastrin is given prior to the study. The disease is routinely clarified by sonography, X-ray imaging or gastroscopy. Complete destruction of parietal cells is not fully reversible.

complications

Achlorhydria is a serious symptom and can lead to severe health problems for the patient. In most cases, the symptom is primarily due to severe diarrhea. In addition, there is also an anemia, which leads mainly to severe paleness, a permanent tiredness and a lower performance of the patient.

Most sufferers also complain of headaches and dizziness. Due to the achlorhydria it also causes indigestion, which can lead to abdominal pain and inflammation in the abdomen. The anemia also causes a numbness in the extremities. Due to dizziness, there are often disturbances in the gait pattern or disturbance of concentration. The everyday life of the patient is severely limited by the achlorhydria.

Treatment by the doctor does not take place directly. The patient must, in most cases, pay attention to a healthy diet that restricts the symptom. In general, the achlorhydria can be severely limited after about a week and leads to no further complications or consequential damages. If the symptom is not treated, it often causes damage to the extremities and internal organs.

When should you go to the doctor?

Achlorhydria must always be treated by a doctor. Accompanying this, the complaints can be alleviated by a number of home remedies and self-help measures. Above all, dietary measures have proved their worth. Thus, the deficiencies can be effectively balanced by vitamin B12, taken for example in the form of appropriate foods (bananas, oranges, etc.) or dietary supplements. The intake of iron-containing foods and preparations can also help against the typical symptoms of achlorhydria.

In order to determine the cause of the achlorhydria, a complaint diary should also be created in which the nature and occurrence of the complaints is recorded. In addition, it may be necessary to take measures against the mental illness that accompanies the illness. It is recommended that you talk with a therapist regularly and work through the issues as part of the treatment. If the achlorhydria is overcome, a suitable nutritional plan should be prepared in consultation with the family doctor or a sports physician. This can be avoided that it comes again to deficiency symptoms and the severe symptoms of achlorhydria.

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Treatment & Therapy

The therapy of achlorhydria differs depending on the cause and severity. In absolute achlorhydria, therapeutic administration of pentagastrin is unable to provoke secretion. On the other hand, the incomplete form of pentagastrin administration can be successful.

The most commonly used therapy steps for absolute achlorhydria are dietary measures. These steps are combined with countermeasures for pernicious anemia. To compensate for the deficiencies of vitamin B12, patients are given intravenous or intramuscular vitamin substitution. This type of therapy is a purely symptomatic therapy.

The cause of the anemia and the lack of secretion of the glands is therefore not canceled by the mentioned treatment steps. Nonetheless, at least the manifest symptoms of those affected improve with the symptomatic therapy. The supportive dietary measures prevent an aggravation of the situation. Iron supplementation may also be required in certain cases as iron is an important component of the blood and thus of oxygen transport.

Outlook & Forecast

Achlorhydria can lead to serious consequences and discomfort for the patient, which can be life-threatening. In most cases, it leads to a pronounced anemia and a strong diarrhea in the patient. The person affected is always tired and fatigue can not be compensated with the help of sleep. Often, the performance is greatly reduced, so that ordinary activities or sports activities can not be carried out easily.

The heart rate is elevated and physical effort can lead to loss of consciousness. The symptoms extremely limit the life of the patient. This is especially the case when paralysis or abnormal sensation occurs in different parts of the body due to achlorhydria. The person concerned has difficulty concentrating and suffers partly from mental illness or depression. Suicidal thoughts may also occur. The movement is restricted and the coordination is difficult.

As a rule, it is possible to treat the achlorhydria, whereby the patient must take medication. With the help of the medication, most symptoms can be treated and contained relatively well, so that the life expectancy of the patient is not reduced.

prevention

The achlorhydria can hardly be actively prevented. Gastric carcinomas are associated with genetic disposition, for example. For autoimmune diseases and the associated destruction of the gastric glands, medicine has not yet agreed on the exact pathogenesis. Since these two diseases are the most common causes of achlorhydria, the prophylaxis is correspondingly difficult.

aftercare

In most cases, those affected by achlorhydria have no direct options for follow-up care. However, these are not necessary because the disease can be treated relatively well. Special complications do not occur. As a rule, in the case of achlorhydria, the person is dependent on the intake of medication in order to alleviate the symptoms of the disease.

It is important to ensure a regular intake of the drugs, which should also be considered interactions with other drugs. If you have any questions, always consult your doctor. Parents need to be mindful of taking the medication regularly, especially in children, to help children grow.

Furthermore, in the case of achlorhydria, a healthy lifestyle with a healthy diet also has a very positive effect on the course of the disease. In this case, especially food with a lot of iron is recommended to counteract the iron deficiency. Also, contact with other victims of achlorhydria may be useful, as it often comes to an exchange of information. The life expectancy of the person affected is not reduced by the illness, however, this is dependent on a life situation therapy.

You can do that yourself

If the composition of gastric acid is pathologically altered, this is usually due to an impairment or destruction of the parietal cells of the stomach. Such impairments are often the result of an underlying disease of the gastrointestinal tract, which can be effectively prevented by a healthy diet. The stomach should not be irritated by over-flavored or spicy foods. High-percentage alcohol and black coffee are better not consumed in large quantities and never on an empty stomach. In addition, regular smaller meals weigh less than large amounts of food at once.

If it has already come to an achlorhydria, it is essential to consult a doctor. But those affected can help alleviate the symptoms. The behavioral measures described above should be strictly observed in order not to unnecessarily burden the stomach. Some of the symptoms of achlorhydria can also be treated by dietary measures. If a vitamin B12 deficiency has occurred, it is recommended to consume fortified foods. Especially useful are herbal milk alternatives and vitamin B12 enriched toothpaste.

Special dietary supplements or iron-containing mineral waters help against the frequently occurring iron deficiency, but because of their idiosyncratic taste they are not commercially available, but can only be tapped directly at the spring in spas.

In case of serious deficiency symptoms, a doctor should be consulted, as well as an ecotrophologist, who will prepare a nutritional plan tailored to the specific needs of the patient.

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