The stomach produces a variety of substances that promote digestion and assimilation. Gastric juice contains hydrochloric acid and pepsinogens, precursors of the family of proteolytic enzymes called pepsins. Parietal cells produce both stomach acid and intrinsic factor, a protein required to bind vitamin B12, prior to its absorption by the small intestine. The secretion of H+ by parietal cells requires an TPase (H+, K+) to pump H+ out of the cell. Chloride ion is exported separately, so that the resulting product is HCl. The pump is activated by histamine stimulation of a cell surface receptor involving cyclic AMP.
Hydrochloric acid is a strong mineral acid which functions to maintain gastric pH between 1.5 to 2.5. Acidity serves three important roles; low pH kills microorganisms in food, it activates pepsinogen, and it unfolds (denatures) proteins, making them more accessible to proteolytic degradation. The gastric lining is protected from the strong acidic environment by a thick layer of mucus.
The incidence of low stomach acid (hypochlorhydria) increases with age.
Atrophic gastritis occurs in 20% to 30% of healthy, elderly, individuals, and is the most common cause of reduced gastric acid production. An estimated 30-50% of people over the age of 60 are believed to produce inadequate stomach acid, although, only 16% hyposecretors in healthy elderly people has been reported(3). In extreme cases, the stomach does not produce acid (achlorhydria) and gastric pH approaches neutrality. Other causes of low gastric acid production include malnutrition and excessive use of antacids and H2 receptor antagonists.
Inadequate stomach acid is linked to maldigestion. This can promote inadequate mineral uptake, due to malabsorption of iron, calcium, zinc and others, and increased risk of intestinal infections due to Candida albicans and parasites. In diabetics, the prevalence of achlorhydria, together with related anemia due to vitamin B12 malabsorption, has been estimated to range from 12 to 41%. Achlorhydria and hypochlorhydria have been linked to peptic ulcer disease and to Helicobacter pylori overgrowth.
Hypochlorhydria can also cause an increased bacterial colonization of the small intestine. (In addition to gastric acid, other factors that limit bacterial colonization include normal bile flow and peristalsis.) It has also been suggested that gastric acid acts as an antitumor defense, and that achlorhydria predisposes patients to gastric cancer.
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