History

Obtain an appropriate history in patients suspected of having achlorhydria. Elicit risk factors for achlorhydria, including prior gastric bypass surgery, history of chronic H pylori infection, chronic PPI use, and autoimmune conditions (eg, diabetes, autoimmune thyroid disease).

Irrespective of the cause, achlorhydria can result in complications such as bacterial overgrowth, intestinal metaplasia, and hip fracture. Therefore, a history of abdominal discomfort, early satiety, weight loss, bowel movement frequency, reflux symptoms, and abdominal bloating should be taken. Since acidic pH facilitates the absorption of iron, achlorhydric patients often develop iron deficiency anemia.^[16]Therefore, patients should be assessed for symptoms of anemia.

Bacterial overgrowth can cause micronutrient deficiencies that result in various clinical neurological manifestations. A complete neurological history, including history of visual changes, paresthesias, ataxia, limb weakness, gait disturbance, memory defects, hallucinations, and personality and mood changes, should also be obtained.

Physical examination

Achlorhydria is not associated with any characteristic physical findings.

Differential Diagnoses

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Author

Divyanshoo Rai Kohli, MD Physician, Pancreas and Liver Clinic, Sacred Heart Medical Center

Divyanshoo Rai Kohli, MD is a member of the following medical societies: American College of Gastroenterology, American Society for Gastrointestinal Endoscopy

Disclosure: Received research grant from: Olympus corporation of Americas.

Coauthor(s)

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, American Society for Gastrointestinal Endoscopy

Disclosure: Nothing to disclose.

Timothy R Koch, MD Professor, Virginia Tech Carilion School of Medicine

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

Disclosure: Nothing to disclose.

Specialty Editor Board

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

Disclosure: Received salary from Medscape for employment. for: Medscape.

Chief Editor

BS Anand, MD Professor, Department of Internal Medicine, Division of Gastroenterology, Baylor College of Medicine

BS Anand, MD is a member of the following medical societies: American Association for the Study of Liver Diseases, American College of Gastroenterology, American Gastroenterological Association, American Society for Gastrointestinal Endoscopy

Disclosure: Nothing to disclose.

Additional Contributors

David Greenwald, MD 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, New York Society for Gastrointestinal Endoscopy, American College of Gastroenterology, American College of Physicians, American Gastroenterological Association, American Society for Gastrointestinal Endoscopy

Disclosure: Nothing to disclose.

Acknowledgements

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.

Achlorhydria Clinical Presentation

History

Physical examination

References

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