Reduced acidity of the stomach: how to determine diet and diet

Everyone knows that the increased acidity of the stomach - it's bad, but do you know what is dangerous low gastric acidity?

To the process of digestion in the stomach proceeded normally, a certain amount of hydrochloric acid, which is produced by its mucosa, is necessary, and the decreased acidity of the stomach causes a lot of health problems.

So why does hypochlorhydria occur and how to distinguish between the increased acidity of the stomach and the decreased one?

[1], [2], [3], [4], [5], [6]

Epidemiology

The real number of people who have an insufficient level of acidity of the stomach, no one knows. However, judging by some reports of practicing European and American gastroenterologists, almost 28% of adults have this problem by the age of forty, and almost 40-45% have a chance to face it at the age of 50. And among people 70 years and older this number increases to more than 75%.

So it should be borne in mind that the older the person, the less hydrochloric acid produces the stomach, which can lead to a condition such as achlorhydria.

[7], [8], [9], [10], [11], [12], [13], [14]

Causes of the reduced gastric acidity

In the list, which includes the main causes of reduced gastric acidity, only one item can be indicated, and this is a reduction in the production of hydrochloric acid - the product of parietal exocrine cells (covering cells) of special intestinal glands - the fundus located deep in the mucous membrane of the fundus ventricul.

But the reasons for reducing the secretion of hydrochloric acid (HCl) gastroenterologists are associated with the following factors:

• infection of the stomach with the bacterium Helicobacter pylori (to ensure its survival, it neutralizes gastric acid with hydrogen nitride);
• atrophy of the gastric mucosa;
• the slowing of metabolism caused by hypothyroidism (a decrease in the functions of the thyroid gland);
• hypochloremic metabolic alkalosis (develops in diseases accompanied by frequent vomiting or diarrhea);
• stomach cancer and / or radiotherapy that affected this organ;
• tumors of islet cells (islets of Langerhans) of the pancreas;
• somatotropic adenoma of the pituitary (at which the synthesis of the somatostatin hormone increases);
• autoimmune lesion of parietal cells of the stomach (immune gastritis) in Sjogren's syndrome;
• lack of zinc in the body;
• deficiency of thiamine (vitamin B1) and niacin (nicotinic acid or vitamin PP).

[15], [16], [17], [18], [19]

Risk factors

Also, experts call such risk factors for reducing gastric acidity, such as:

• malnutrition and severely restricting diets;
• excessive intake of carbohydrates;
• inflammatory bowel diseases, which have a general inhibitory effect on the secretion of HCl;
• stresses and a chronic depressive state (contributing to the development of functional achilias);
• celiac disease (gluten intolerance to cereals);
• elderly age.

In addition, neutralizes the effect of gastric acid acids, long-term intake of sodium bicarbonate (soda) and relieve heartburn of antacids. Antihistamines (blocking H2-histamine receptors) and antiulcer drugs of the proton pump inhibitor group suppress the functions of the gastric lining cells and the production of HCl. But antagonists of acetylcholine receptors (m-cholinolytics) lead to a decrease in secretion of gastric juice due to a decrease in the influence of the vagus nerve.

[20], [21], [22], [23], [24], [25], [26], [27]

Pathogenesis

Most often the pathogenesis of disturbances of hydrochloric acid secretion is seen in the problems of nervous, paracrine and endocrine control of the multistage process of its production.

For example, the activity of G cells of gastric antrum mucosa (from the Latin antrum - cavity) producing gastrin and functioning only at a certain pH level may be insufficient, as well as partial dysfunction of ECL cells, the source of gastric histamine.

Persons involved in acid production disorders may be inadequately receptive receptors of the neurotransmitter acetylcholine, the release of which in the stomach (after ingestion of food) should stimulate its production.

Disturbances in the transfer from the cytoplasm to the plasma membrane of parental cells necessary for the formation of hydrochloric acid hydrogen protons (H ⁺ ) are not excluded . This process is provided by a transport enzyme - hydrogen-potassium adenosine triphosphatase (H ⁺ / K ⁺ -ATP) or proton pump, and here, due to insufficient strength of cell membranes, there may be losses of H ⁺. And the density of membranes and their compounds in parietal cells, as it turned out, is regulated by the glycoprotein cytokine VEGF (vascular endothelial factor), which may be lacking under certain conditions, in particular, during prolonged oxygen starvation of tissues, the presence of foci of chronic inflammation or the constant presence of mycotoxins in the body mold and other fungi.

Quite often, the pathogenesis of reduced acidity lies in the imbalance of substances that can inhibit the secretion of gastric juice: enterogastron (intestinal gastrointestinal hormone), secretin (especially its vario-vasoactive intestinal peptide), somatostatin hormone (produced by gastric mucosal D-cells and regulating gastrin release).

[28], [29], [30], [31], [32], [33], [34], [35], [36], [37], [38], [39], [40]

Symptoms of the reduced gastric acidity

The first signs of a high pH of gastric juice appear after eating - in the form of belching and a feeling of discomfort in the stomach. And belching (with a taste of consumed food) may be a few hours after eating. This symptom is proof that the food is still in the stomach, while with normal acidity it should already be in the small intestine. Therefore, a feeling of discomfort in the abdomen can accompany nausea with a decreased acidity of the stomach.

There are also symptoms of decreased gastric acidity, such as flatulence (bloating); intestinal disorders (diarrhea or constipation); halitosis (bad smell from the mouth), and the tongue may have a white coating; presence of undigested food fragments in the stool; weight loss; itching in the rectum; chronic fatigue.

Pain with reduced acidity of the stomach is rare and usually stretches from the stomach to the throat, appearing after heartburn.

By the way, heartburn with a reduced acidity of the stomach - a common phenomenon, as with increased: the difference lies in the cause of gastroesophageal reflux. The fact that the lack of gastric acid leads to an increase in intra-abdominal pressure, under the influence of which the opening of the lower esophageal sphincter, which separates the esophagus and stomach. And even a microscopic amount of acid, got on the mucosa of the esophagus, is enough to start heartburn.

The long-term decrease in the level of hydrochloric acid in gastric juice and the related deficit of certain substances (mentioned above) can say:

• chronic fungal infections and recurrent intestinal infestations;
• food allergies and poisoning with chemicals;
• irritable bowel syndrome;
• weakness of the extremities, paresthesia (numbness and tingling in the limbs);
• Acne, eczema and skin rashes;
• increased dryness of the skin, brittle nails, thinning and hair loss;
• depression, sleep and memory problems.

What is the danger of reduced gastric acidity?

This question can be answered extremely briefly: a sufficient level of acidity of the stomach and gastric juice is crucial for good digestion and the state of the immune system.

Complications and consequences

Listing the specific consequences and complications of high pH of the stomach, experts emphasize the primary importance of acid for protein digestion: HCl activates the transformation of the proenzyme pepsinogen II into the enzyme pepsin, which provides the process of breaking the amino acid bonds of protein foods by proteolysis.

Acid is necessary for the proper functioning of the sphincter of the stomach and further promotion of its contents (chyme); for neutralization of pathogenic bacteria and yeast fungi entering the gastrointestinal tract; for pancreatic pancreatic juices. Finally, it is only in an acidic environment that the necessary calcium, magnesium, iron, zinc, copper, selenium, etc., are absorbed by the body.

So the consequences and complications of reduced acidity can be expressed in increasing the susceptibility of the organism to intestinal infection and enteroviruses; deficiency of proteins due to their malabsorption; iron deficiency anemia; deficiency of vitamins C, A, E, B12 and folic acid; reduction of bile secretion and pancreatic enzymes.

All this can lead to the development of a wide range of pathologies. So, toxins of intestinal microbes, getting into the bloodstream, cause allergic or inflammatory reactions in the distal areas, for example, interstitial cystitis. There is a tendency to develop intestinal dysbiosis.

Properly unquenched proteins acidify the blood (because of what lose the strength of the bone of the skeleton) and repeatedly increase the level of urea blood, which increases the load on the liver and kidneys. A deficiency in the body of cyanocobalamin (vitamin B12) and folic acid leads to the development of Addison-Birmer disease (megablastic anemia) with numerous neurological manifestations.

[41], [42], [43], [44], [45], [46], [47], [48]

Diagnostics of the reduced gastric acidity

With a certain symptomatic similarity to high acidity, the diagnosis of a decreased acidity of the stomach often leads to the setting of an erroneous diagnosis. According to some reports, this occurs in 10-15% of cases in patients up to 40-50 years of age and at least in half of cases - in patients older than 60-65.

For the detection of pathology, blood tests are required: biochemical, for antibodies to Helicobacter pylori, for PgII (level of pepsinogen) and serum gastrin, for residual urea nitrogen. To confirm Helicobacter infection, an air test is performed - the composition of the patient's exhaled air is examined for the presence of ammonia.

It is necessary to study the composition of gastric juice with the determination of its pH. The traditional method - aspiration (sounding) is still used, but it gives a significant error in the results. Also read - Study of gastric contents

To establish the acidity of all parts of the stomach at the same time allows instrumental diagnosis in the form of intragastric (intragastric) pH-metry, carried out with the aid of the device acidogastrometer.

[49], [50], [51], [52], [53], [54], [55], [56], [57], [58], [59]

Differential diagnosis

Especially important in gastroenterology is differential diagnosis, since many diseases do not have specific symptoms. For example, in elderly patients with low acidity of the stomach fatigue after eating is written off for old age, and rectal itching is often diagnosed as hemorrhoids.

How to distinguish the increased acidity of the stomach from a decreased?

Let's start with the fact that for the indicator of neutral pH - the hydrogen index (the level of H ⁺ in the solution) pure water is taken: pH - 7.0. By the way, the pH of human blood plasma is normally 7.35-7.45.

The higher the pH, the lower the acidity level and, conversely, vice versa.

When measuring pH on an empty stomach in the lumen of his body and on the mucous membranes of this localization, the physiological norm of acidity is below 2.0. A pH for gastric juice is normally 1.0-2.0. And this is the most favorable "working conditions" for the gastric enzyme pepsin.

If the hydrogen index exceeds 4-4.5, that is pH> 4-4.5, the acidity of the stomach is depressed.

It should be noted that all medical textbooks indicate the acidity of the antrum of the stomach in a very wide range: from pH 1.3 to pH 7.4. The theoretically possible minimum of gastric acidity was taken as 8.3. A max level is the pH value of the order of 0.9.

[60], [61], [62], [63], [64], [65], [66]

Treatment of the reduced gastric acidity

The presentation of doctors about the wider prevalence of hyperacidity of stomach and errors in diagnosis lead to the fact that patients are prescribed certain medications that can not be used with reduced acidity.

Thus, the treatment of reduced gastric acidity excludes the use of such drugs as Almagel (Alumag, Maalox, Gastal and other trade names) - an antacid that neutralizes the hydrochloric acid of gastric juice. All antacids only aggravate the problem, but they are actively promoted to the market as a universal remedy for heartburn.

It is contraindicated to treat lowered acidity with antisecretory agents Omez (Omeprazole, Omitox, Gastrozol, etc.), as well as Controls preparations (Pantoprazole, Sanpraz, Nolpaz), which are related to proton pump inhibitors (see the section on the pathogenesis of reduced gastric acidity ).

Anti-ulcer drugs of bismuth-De-Nol (Gastro-norms) and Bismofalk are not a means of drug therapy of this pathology.

Is it possible to increase the secretion of hydrochloric acid and how to increase the reduced acidity of the stomach? Given the complexity of the process and the polytheology of its disorders in gastroenterology, the easiest way to solve the problem is to use it - it is recommended to take HCl preparations and enzyme drugs that make up for the lack of endogenous digestive enzymes.

So hydrochloric acid - a solution of hydrochloric acid - is taken during meals in a dosage determined by the doctor according to the results of the examination. Natural canned gastric juice (animal origin) is also taken in the process of eating - on a tablespoon to three times during the day. In the same way and in the same dosage should be taken Pepsin (powder for dissolution in water) or liquid Pepsidil.

Helps digestion enzyme preparation Oraza (in the form of granules), which is recommended to take during meals or right after it three times a day - a teaspoon. Treatment can be carried out for a month. When using this tool, diarrhea can become stronger.

Pangrol (analogues - Pancitrat, Festal, Creon, Mezim) on the basis of the digestive enzyme of pancreatin is taken one to two capsules before meals. The drug can cause nausea and intestinal disorders, but long-term use is fraught with an increase in the content of uric acid in the blood and urine.

Means that increase the acidity of the stomach, few. For example, to activate the secretion of gastric juice, bitterness is used - a tincture of wormwood (15-20 drops 20 minutes before meals). Aristocalls can be prescribed (20-25 drops three times a day, after meals).

Cytoflavin (succinic acid + vitamins) is recommended to take 30 minutes before meals - one or two tablets twice a day. If there are no problems with kidney stones, you can use a complex of vitamins and minerals Calcemin - once a day, one tablet. It is also advisable to take vitamins B1, B9, B12, PP.

How to increase the lowered stomach acidity?

Pay attention to foods that increase the acidity of the stomach. To them, nutritionists include: all vegetables and fruits with a high content of ascorbic acid (vitamin C); The root of ginger (in the form of warm ginger tea, which also helps reduce bloating in the intestines); fermented vegetables (sauerkraut - enough as a snack 100 g before the main course); all sour-milk.

Increase the supply of zinc needed for the production of HCl in the stomach, you can, using pumpkin seeds, potatoes, beans, peanuts, cheeses, whole grains and bread, brown rice. And to improve the absorption of zinc, take vitamins C, E, B6 and magnesium.

What can offer an alternative treatment for reduced gastric acidity? Apple cider vinegar (tablespoon per glass of water, take half an hour before meals); freshly squeezed juice from white cabbage (in half with water) - twice a day for 100 ml; broth of rose hips (no more than 300 ml per day)), as well as eating before drinking water with the addition of lemon juice.

But the broth of oats, as well as the flax seed, despite the presence of omega-acids in it, are not used in the treatment of reduced acidity. And to provide the body with omega-3 fatty acid is better to take capsules of fish oil (1 capsule once a day).

Practiced in alternative medicine, herbal therapy with a decrease in the level of hydrochloric acid in gastric juice is carried out using fresh dandelion and plantain leaves, which are recommended to be added to food (without heat treatment).

In the collection of herbs in this pathology included the same leaves of plantain, fruits of coriander; leaves of trifolium, gentian, silvery tent, gravel, as well as chamomile (flowers). The mixture for preparation of broth should contain the same amount of all ingredients, for example, three tablespoons. For the broth, take a tablespoon of the mixture for 0.5 liters of water, boil for 15 minutes, then infused, filtered and filled with boiled water to the original volume. It is recommended to use in breaks between meals throughout the day - for 100-150 ml. After a three-week course, you need to take a break for a week.

You can also drink a decoction of dandelion roots, which are excavated in the beginning of autumn, cleaned, finely cut and dried. Brew a teaspoon per cup of boiling water, drink a day in several receptions.

Prevention

To date, the prevention of hypochlorhydria is to reduce the protein in the diet of animal origin (which is poorly digested with reduced acidity) and replace them with plant proteins of legumes, as well as in reducing the use or exclusion of sugar. In here fiber should be enough.

Recommendations dieticians to ensure proper digestion boil down to the rejection of food containing preservatives and other supplements, and the transition to separate meals. That is, do not use carbohydrates along with proteins (meat is best eaten with vegetables that do not contain starches), and fruits are consumed separately, and not during the main meal.

Also, doctors advise to increase the consumption of probiotic products, which will help to balance the microflora of the stomach and intestines. At the expressed symptoms of an atrophic condition of a mucous stomach it is recommended to observe a diet at an atrophic gastritis.

[67], [68], [69], [70], [71]

Forecast

It is difficult to predict what will turn out the low acidity of the stomach. However, some experts consider it a risk factor for cancer. This opinion is based on the established studies of involvement in malignant gastroenterological diseases Helicobacter Pylori. It is also known that the reduced acidity of the stomach is very common among the Japanese, and the main cause of their death is stomach cancer.

[72], [73], [74], [75], [76]