Low stomach acid tests

[mickeymouse42]

I asked some questions about B12 and Diarrhoea here:

healthunlocked.com/pasoc/po...

Some people came back suggesting that low stomach acid (hypochlorhydria or achlorhydria) is a cause of stomach acid. I did the sodium bicarbonate "burp" test and it seems I might have low stomach acid.

I have got 2 questions.

1) references

Are there any NHS, NICE, BMJ or other UK standard references that confirm this link? The British Society of GE guidelines (gut.bmj.com/content/67/8/13... makes a very short reference to achlorhydria in section 6.5 - small bowel bacterial overgrowth (SBBO):

"Authors have also reported a high prevalence of SBBO in situations associated with achlorhydria such as old age or medical therapy with proton pump inhibitors."

Can anyone point me at something a bit simpler that I can forward to my GP - this heathline article healthline.com/health/achlo... is roughly what I am looking for but ideally it has the NHS or BMJ stamp of authority.

Ideally there would be something on the NHS website but the terms low stomach acid, hypochlorhydria or achlorhydria don't yield any results.

2) GP tests.

I know that GE consultants have access to 24 hour ph monitoring tests and probably take samples via endoscopy.

Are there any tests that GPs can do for low stomach acid? I found this article on the BMJ (bestpractice.bmj.com/topics... which lists best practice and it mentions an intragastric pH test in its first line of tests. The authors are American so this test may not be available to GPs in the UK.

Anyone know whether a UK GP has access to an intragastric pH test available? They all look like hospital tests to me.

The article refers to serum gastrin, parietal cell antibodies and intrinsic factor antibodies tests. I might try asking for a serum gastrin test as this would be high if stomach acid is low.

Has anyone here who has chronic diarrhoea had a serum gastrin test done by their GP?

[Gambit62 Administrator]

I think you would need to ask for a referal to a gastroenterologist to get a gastrin test done in the UK.

[mickeymouse42 in reply to Gambit62]

thanks. I suspect that's the guess. I couldn't get the PA tests because my B12 levels were fractionally above 197ng/L so I'll probably hit the same barrier. Any other tests that a GP can do to test for low stomach acid?

[Gambit62 Administrator in reply to mickeymouse42]

I suspect not - its something that the NHS just doesn't treat - the symptoms are the same as those for high stomach acidity and if treated it would therefore be treated in the same way - probably with PPIs

[mickeymouse42 in reply to Gambit62]

yes i would guess the same. As far as I understand it, a paraphrase of the section in the BSG SBBO section would equate to saying that low stomach acid (achlorhydria) stops the small intestine from being sterile and this leads to bacteria which feed on B12 and do all sorts of other bad things (SIBO, BAM etc). It's pretty confusing that they use SBBO rather than SIBO. Worse still, they seem to be implying that PPIs are the worst thing to take when achlorhydria is involved. It's so confusing....

[Gambit62 Administrator in reply to mickeymouse42]

On one level PPIs are the worst thing for treating low stomach acidity - they treat the symptoms and are very good at that - but don't treat the cause.

[mickeymouse42 in reply to Gambit62]

what's better - apple cider vinegar?

[Gambit62 Administrator in reply to mickeymouse42]

It really does depend on the circumstances but if the problem is lack of stomach acidity then it does imply that something acid would correct the problem without actually making the stomach acidity lower. I certainly find that if I have heart burn taking something acidic clears it quite quickly - even a segment of a satsuma which I used on one occasion.

[nellie237 in reply to Gambit62]

I find eating satsumas helps too.