What does Achlorhydria mean?
Acidifying agents are used in condition where there is absence or insufficient secretion of hydrochloric acid in stomach which leads to disease called Achlorhydria or Hypochlorhydria. Achlorhydria can be treated by various acidifying agents like ammonium chloride, dilute HCl, Calcium chloride etc.
Causes of Achlorhydria:
What causes Achlorhydria?
The cause of achlorhydria in first case may be subtotal gastrectomy, atrophic gastritis, carcinoma, gastric polyp etc while in later case it may be chronic nephritis, tuberculosis, hyperthyroidism, chronic alcoholism, sprue, pellagra etc. The symptoms vary with associated disease but they generally include mild diarrhoea or frequent bowl movement, epigastric pain and sensitivity to spicy food.
The pH of stomach is 1.5 -2 when empty and rises to pH 5-6 when food is ingested. The pH of stomach is so low because of the secretion of HCl. Gastric HCl act by destroying the bacteria in the ingested food and drinks. It softens the fibrous food and promotes the formation of the proteolytic enzyme pepsin. This enzyme is formed from pepsinogen at acidic pH (>6). Pepsin helps in the metabolism of proteins in the ingested food. Therefore lack of HCl in the stomach can cause Achlorhydria.
- Pernicious anemia (anti-parietal and anti-intrinsic factor antibodies): It is an autoimmune phenomenon in which antibodies are formed. These autoantibodies cause the autoimmune destruction of parietal cells leading to atrophic gastritis.
- Use of antisecretory medications: Short-term standard dose treatment with PPI has been shown to have low risk, but long-term use of PPI has been linked to hypochlorhydria.
- Helicobacter pylori infection: Acute H. pylori infection of gastric epithelial cells represses H-K-ATPase alpha subunit gene expression leading to transient hypochlorhydria and supporting H. pylori proliferation. This growth of H. pylori may even initiate a pathological process causing gastric cancer.
- Gastric bypass: Gastric bypass is a gastric exclusion operation performed in patients with massive obesity to reduce food intake. Studies show that the acid secretion unbuffered by the food in the excluded stomach results in lowered gastrin secretion hence leading to achlorhydria in such patients.
- VIPomas: VIPoma is an endocrine tumor that usually arises from beta-pancreatic cells and secretes Vasoactive intestinal peptide. It may be associated with MEN1. The massive amounts of VIP secretion cause watery diarrhea, hypokalemia, achlorhydria, vasodilation, hypercalcemia, and hyperglycemia.
- Hypothyroidism: Thyroid hormone plays a role in hydrochloric acid secretion hence hypothyroidism can lead to achlorhydria.
- Radiation to stomach: Radiation to stomach has also been reported to cause achlorhydria.
- Gastric cancer: Animal studies have shown evidence of achlorhydria in gastric cancer.
- Ref: Achlorhydria
Rawish Fatima; Muhammad Aziz
Types of achlorhydria
Two types of achlorhydria are known:
1) where the gastric secretion is devoid of HCl, even after stimulation with histamine phosphate
2) where gastric secretion is devoid of HCl, but secreted upon stimulation with histamine phosphate.
What is an acidifying agent?
What drugs acidify urine?
Acidifying Agents in Pharmaceuticals
Acetic Acid, Glacial
Citric Acid, Anhydrous
Citric Acid Monohydrate
Hydrochloric Acid, Diluted
Phosphoric Acid, Diluted
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