TY - JOUR
T1 - Creating a Framework for Treating Autoimmune Gastritis
T2 - The Case for Replacing Lost Acid
AU - Taylor, Lori
AU - McCaddon, Andrew
AU - Wolffenbuttel, Bruce H.R.
N1 - Publisher Copyright:
© 2024 by the authors.
PY - 2024/3/1
Y1 - 2024/3/1
N2 - Autoimmune gastritis (AIG) is characterized by the destruction of gastric parietal cells, resulting in hypochlorhydria and eventual achlorhydria, as oxyntic glands in the corpus are destroyed and become atrophic. The permanent loss of gastric acid has many impacts—both theoretical and documented. The most concerning of these are hypergastrinemia and increased N-nitroso compounds, both of which increase the risk of gastric cancers. While known deficiencies of B12 and iron are often replaced in AIG, acid is not. Moreover, patients with AIG are often prescribed acid suppression for a stomach that is decidedly no longer acidic, worsening the sequelae of gastric atrophy. Betaine hydrochloride (BHCL) is a short-acting acidifying agent, available over the counter in capsule form. Mealtime acid supplementation has an historic basis and could ameliorate many AIG-related gastrointestinal symptoms. Theoretically, acidification could also reduce the potential for hypergastrinemia and the production of N-nitroso compounds, consequently reducing the risk of gastric cancers. Supplemental vitamin C may also help in preventing gastric N-nitroso formation, regardless of the gastric pH. This narrative review describes the functions of gastric acid in gastrointestinal and immune health, documents the effects of hypochlorhydria in AIG, and proposes potential options for safely re-establishing the acid milieu of the stomach for patients with AIG.
AB - Autoimmune gastritis (AIG) is characterized by the destruction of gastric parietal cells, resulting in hypochlorhydria and eventual achlorhydria, as oxyntic glands in the corpus are destroyed and become atrophic. The permanent loss of gastric acid has many impacts—both theoretical and documented. The most concerning of these are hypergastrinemia and increased N-nitroso compounds, both of which increase the risk of gastric cancers. While known deficiencies of B12 and iron are often replaced in AIG, acid is not. Moreover, patients with AIG are often prescribed acid suppression for a stomach that is decidedly no longer acidic, worsening the sequelae of gastric atrophy. Betaine hydrochloride (BHCL) is a short-acting acidifying agent, available over the counter in capsule form. Mealtime acid supplementation has an historic basis and could ameliorate many AIG-related gastrointestinal symptoms. Theoretically, acidification could also reduce the potential for hypergastrinemia and the production of N-nitroso compounds, consequently reducing the risk of gastric cancers. Supplemental vitamin C may also help in preventing gastric N-nitroso formation, regardless of the gastric pH. This narrative review describes the functions of gastric acid in gastrointestinal and immune health, documents the effects of hypochlorhydria in AIG, and proposes potential options for safely re-establishing the acid milieu of the stomach for patients with AIG.
KW - atrophic gastritis
KW - autoimmune gastritis
KW - B12 deficiency
KW - betaine hydrochloride
KW - H2 receptor antagonists
KW - hypochlorhydria
KW - iron deficiency
KW - pernicious anemia
KW - proton pump inhibitors
KW - vitamin C
UR - http://www.scopus.com/inward/record.url?scp=85187420094&partnerID=8YFLogxK
U2 - 10.3390/nu16050662
DO - 10.3390/nu16050662
M3 - Review article
C2 - 38474790
AN - SCOPUS:85187420094
SN - 2072-6643
VL - 16
JO - Nutrients
JF - Nutrients
IS - 5
M1 - 662
ER -