{
  "abstract": "Introduction Hypochlorhydria or low stomach acid is a diagnosis often given by alternative medicine for the unexplained cause of upper gastrointestinal symptoms. However, gastric acid output is seldom measured objectively.Methods We retrospectively looked at data from 30 consecutive patients undergoing assessment of gastric acid output (median age 49 years [28–77 years], 17 female) at a single centre in the UK. This was performed by placing a nasogastric pH sensor in the stomach at 55-60 cm from the nares. Fasted baseline gastric pH levels were measured for 30 minutes then patients ingested 120 ml of nutrient shake (Ensure® Plus, 180 kcal) mixed with 120 ml of water as per the protocol suggested by Weinstein et al1. Gastric pH was measured for a further 60 minutes. Gastric reacidification was time taken to return to baseline pH. All patients completed the ROME IV modules for gastroduodenal disorders and irritable bowel syndrome (IBS), Gastrointestinal Symptom Rating Scale (GSRS) and Reflux Symptom Index (RSI). Responses were statistically analysed against gastric acid output measures.Results The median fasted baseline gastric pH was 1.9 [1.5–6.8]. In total, 33.3% (10/30) of patients had evidence of reduced gastric acid output: 2 patients had achlorhydria (gastric pH >4 for entire study) and 8 patients had hypochlorhydria (post meal reacidification time >50 minutes). The prevalence of low stomach acid in those with functional dyspepsia was 41.2% (7/17) and 26.7% (4/15) with IBS. Gastric reacidification time was inversely correlated with nausea (-0.416, p = 0.028) and positively correlated with hoarseness (0.467, p = 0.014). Patients with Sjögren’s disease had a higher baseline gastric pH (pH 4.5 vs pH 2.2, p = 0.018).Conclusion Around 1 in 3 patients with unexplained upper gastrointestinal symptoms have objective evidence of low stomach acid. This may be higher in those with functional dyspepsia or Sjögren’s disease.Reference Weinstein DH, deRijke S, Chow CC, Foruraghi L, Zhao X, Wright EC, Whatley M, Maass-Moreno R, Chen CC, Wank SA. A new method for determining gastric acid output using a wireless pH-sensing capsule. Aliment Pharmacol Ther. 2013;37(12):1198–209. doi: 10.1111/apt.12325",
  "authors": [
    {
      "affiliations": [
        "Functional Gut Clinic, Manchester, United Kingdom"
      ],
      "name": "Jordan Haworth"
    },
    {
      "affiliations": [
        "Functional Gut Clinic, Manchester, United Kingdom"
      ],
      "name": "Mylto Ellina"
    },
    {
      "affiliations": [
        "Functional Gut Clinic, Manchester, United Kingdom"
      ],
      "name": "Sienna Watts"
    },
    {
      "affiliations": [
        "Functional Gut Clinic, Manchester, United Kingdom"
      ],
      "name": "Liz Kenyon"
    },
    {
      "affiliations": [
        "Functional Gut Clinic, Manchester, United Kingdom"
      ],
      "name": "Luisa Keen"
    },
    {
      "affiliations": [
        "Functional Gut Clinic, Manchester, United Kingdom"
      ],
      "name": "Andres Vales"
    },
    {
      "affiliations": [
        "Functional Gut Clinic, Manchester, United Kingdom"
      ],
      "name": "Sam Treadway"
    },
    {
      "affiliations": [
        "Functional Gut Clinic, Manchester, United Kingdom"
      ],
      "name": "Anthony Hobson"
    }
  ],
  "title": "P309 How common is low stomach acid in patients with unexplained upper gastrointestinal symptoms?",
  "uid": "b62fea30-5373-5272-b9d3-845a3ec1d4d3"
}