Achlorhydria Follow-up

  • Author: Jennifer (Zone-En) Lee, MD; Chief Editor: Julian Katz, MD   more...
 
Updated: Aug 18, 2011
 

Further Outpatient Care

  • Patients with achlorhydria may develop ECL cell hyperplasia and gastric carcinoids. However, most experts believe that regular upper endoscopic surveillance is not justified.
  • Achlorhydria leads to hypergastrinemia. The trophic effect of gastrin leading to colorectal adenocarcinoma has been observed in knockout mouse models.
  • Patients on long-term PPI treatment may develop drug-induced achlorhydria. These patients have been observed to have reduced serum vitamin B-12 (cobalamin) levels. Vitamin B-12 injections may be indicated in this subgroup.
  • Bacterial overgrowth and subsequent micronutrient deficiencies can occur in patients with achlorhydria. Patients with a history of gastric bypass surgery or long-term PPI use are predisposed to bacterial overgrowth. These patients should be tested for various nutrient deficiencies, including thiamine levels and calcium levels. Patients should undergo hydrogen breath testing. If the test results are positive, these patients should be treated with antimicrobial therapy for bacterial overgrowth. The patients should receive appropriate supplements to correct deficient nutrients. However, this supplementation may not be sufficient to maintain adequate nutrient levels without the treatment of the bacterial overgrowth.
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Inpatient & Outpatient Medications

  • Parenteral vitamin B-12 may be important in selected patients.
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Complications

  • Atrophic gastritis (and associated achlorhydria) has been considered to be a potential precursor to gastric carcinoma. It is also related (given the comorbidities) to hip fracture and osteoporosis.
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Prognosis

Small bowel bacterial overgrowth is a chronic condition. Retreatment may be necessary once every 1-6 months. There are reports of cycling of antibiotics to reduce the risk of antibiotic resistance.

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Contributor Information and Disclosures
Author

Jennifer (Zone-En) Lee, MD  Fellow, Section of Gastroenterology, Georgetown University School of Medicine, Washington Hospital Center

Jennifer (Zone-En) Lee, MD is a member of the following medical societies: American College of Gastroenterology, American Gastroenterological Association, and American Society of Gastrointestinal Endoscopy

Disclosure: Nothing to disclose.

Coauthor(s)

Timothy R Koch, MD  Professor of Medicine (Gastroenterology), Georgetown University School of Medicine

Timothy R Koch, MD is a member of the following medical societies: American College of Gastroenterology, American Gastroenterological Association, and American Physiological Society

Disclosure: Nothing to disclose.

Hiral Shah, MD  Chief Resident, Department of Internal Medicine, Georgetown University Hospital at Washington Hospital Center

Hiral Shah, MD is a member of the following medical societies: American College of Gastroenterology, American College of Physicians, American Gastroenterological Association, and American Medical Association

Disclosure: Nothing to disclose.

Specialty Editor Board

David Greenwald, MD  Associate Professor of Clinical Medicine, Fellowship Program Director, Department of Medicine, Division of Gastroenterology, Montefiore Medical Center, Albert Einstein College of Medicine

David Greenwald, MD is a member of the following medical societies: Alpha Omega Alpha, American College of Gastroenterology, American College of Physicians, American Gastroenterological Association, American Society for Gastrointestinal Endoscopy, and New York Society for Gastrointestinal Endoscopy

Disclosure: Nothing to disclose.

Francisco Talavera, PharmD, PhD  Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Medscape Salary Employment

James L Achord, MD  Professor Emeritus, Department of Medicine, Division of Digestive Diseases, University of Mississippi School of Medicine

James L Achord, MD is a member of the following medical societies: American Association for the Study of Liver Diseases, American College of Gastroenterology, American College of Physicians, American Gastroenterological Association, American Medical Association, American Society for Gastrointestinal Endoscopy, Mississippi State Medical Association, New York Academy of Sciences, Sigma Xi, and Southern Medical Association

Disclosure: Nothing to disclose.

Alex J Mechaber, MD, FACP  Senior Associate Dean for Undergraduate Medical Education, Associate Professor of Medicine, University of Miami Miller School of Medicine

Alex J Mechaber, MD, FACP is a member of the following medical societies: Alpha Omega Alpha, American College of Physicians-American Society of Internal Medicine, and Society of General Internal Medicine

Disclosure: Nothing to disclose.

Chief Editor

Julian Katz, MD  Clinical Professor of Medicine, Drexel University College of Medicine

Julian Katz, MD is a member of the following medical societies: American College of Gastroenterology, American College of Physicians, American Gastroenterological Association, American Geriatrics Society, American Medical Association, American Society for Gastrointestinal Endoscopy, American Society of Law, Medicine & Ethics, American Trauma Society, Association of American Medical Colleges, and Physicians for Social Responsibility

Disclosure: Nothing to disclose.

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