Inability to produce gastric acid. Most commonly caused by gastric atrophy. Gastric atrophy, with or without autoimmune gastritis, is present in about 15% of older people and is thought to be initiated by infection with Helicobacter pylori.
Usually asymptomatic but may present with signs and/or symptoms of iron, cobalamin (vitamin B12), or calcium deficiency and may predispose to enteric infection with organisms such as Clostridium difficile, Salmonella, and Campylobacter.
May interfere with the absorption of certain drugs including thyroxine, ketoconazole, itraconazole, and dipyridamole.
The most common cause of hypergastrinemia.
Although the prognosis is excellent, it carries a small increased risk for the development of gastric adenocarcinoma and gastric carcinoid tumor.
- age >60 years
- female sex
- autoimmune disorders
- decreased exercise tolerance
- skin and conjunctival pallor
- paresthesias and difficulty ambulating
- nutritional deficiency (cobalamin, iron, calcium, vitamin D)
- enteric infection
- memory loss, irritability, depression, and dementia
- ataxia, shuffling gait, decreased position sense, decreased vibration sense
- pale, smooth, and glossy tongue
1st Tests To Order
- biopsy of corpus and/or fundus of stomach
- intragastric pH
Other Tests to Consider
- serum gastrin
- gastric acid secretory test (gastric analysis)
- parietal cell antibodies
- intrinsic factor antibodies
- urea breath test: Helicobacter pylori infection
- histology: Helicobacter pylori infection
- rapid urease test on biopsy samples: Helicobacter pylori infection
- stool antigen test: Helicobacter pylori infection
- serology for Helicobacter pylori infection
- serum pepsinogen I and II (PGI and PGII)
- Helicobacter pylori testing
- with Helicobacter pylori infection
- Helicobacter pylori eradication therapy
- with cobalamin deficiency
- parenteral vitamin B12
- with iron deficiency
- iron replacement therapy + ascorbic acid
- with calcium deficiency
- calcium + vitamin D