Intriguing Old Reserach detailing Low and No Stomach Acid in Celiacs

[Posterboy]

To Forum Members,

I recently was doing research in PubMed about low stomach acid and came across intriguing old research that details it's presence in/with a Celiac and DH diagnosis.

see this link

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Here is the abstract in it's entirety.

Open Original Shared Link 1985 Mar;20(2):133-40.

Gastric morphology and function in dermatitis herpetiformis and in coeliac disease.

Open Original Shared Link, Open Original Shared Link, Open Original Shared Link, Open Original Shared Link, Open Original Shared Link.

Abstract

"Gastric acid secretory capacity was evaluated in 116 patients with dermatitis herpetiformis by means of the pentagastrin test. Endoscopic gastric mucosal biopsy specimens were obtained from both the body and the antrum in 90 of them. Forty-eight patients (41%) had a maximal acid output less than 10 mmol/h, and 30 of them (26%) were achlorhydric. The frequency of achlorhydria increased with age, and 27 out of 58 patients (47%) more than 50 years old were achlorhydric. Antrum-sparing chronic atrophic gastritis was present in 92% of the achlorhydric patients, and hypergastrinaemia and serum parietal cell antibodies were found in most of them. The prevalence of chronic gastritis of the body and of the antrum increased with age. There was no correlation between atrophic gastritis or achlorhydria and small-intestinal villous atrophy, the results of the D-xylose test, and blood folate and serum zinc determinations. The transferrin saturation index was lower in patients with achlorhydria. The frequency of achlorhydria was significantly higher in patients with dermatitis herpetiformis than in 69 patients with coeliac disease."

The question is what does it mean?

I see the high association between no stomach acid and DH as causal. (triggering) at 90+ percent a direct association.

But the relatively high association of Low Stomach could only be casual (associated with) but not definitely triggering but possibly causing someone with Low/No stomach acid to be diagnosed as Celiac/NCGS patients instead.

This research being 30+ years old it can be easily over looked.

I have found treating my Low Stomach acid helped my GI problems.

If it is an Esophageal pH Test could confirm your stomach acid levels.

Open Original Shared Link

Is this definitive research in your mind that indeed no stomach acid is triggering this immune reaction.

I was not expecting to find previous research that studied this topic.

More Recent research on PPIs indicate low stomach caused by the use of PPIs can/could trigger a Celiac diagnosis.

see this article about this topic.

Does/Is low or even No stomach acid being confused for Celiac disease today?

I would love to hear your thoughts?

I share this research in the hope that it will rediscovered again and studied again to see if it can replicated in the hopes that treating one's Low/No stomach acid might help others.

This does not mean you yourself will have low stomach acid . . but you won't know if you don't test for it.

I think with this high association in those who have received a Celiac diagnosis further testing to rule low/no stomach acid is warranted.

Share your thoughts, opinion, ideas and feedback.

I start this thread to kick start your thinking?  And to invite honest inquiry as the role stomach acid plays in GI health.

It is (low stomach/no stomach) is known to be linked/occur in chronic gastritis so it seems only logical it would at least be casual in Celiac/NCGS patient.

See this link on Chronic Gastritis and the prevalence of Low/No stomach in chronic gastritis.

Open Original Shared Link

they estimate quoting  "One may estimate that more than half of the world population have this disease in some degree and extent, indicating that even many hundreds of millions of people worldwide may have chronic gastritis in a form or other."

What if the 1/3 of the population that might develop NCGS or celiac disease is just another clinical presentation of chronic gastritis?

I think it what the research says to me . . triggered by either low or no stomach acid?

Your thoughts and comments are encouraged but I found treating my low stomach acid helped my chronic gastritis.

2 Timothy 2:7 Please Consider what this research says and may the Lord lead you on your continued journey.

I hope this research jogs your thinking.  I know it confirmed mine . . but I am open to being wrong.

A man/woman who corrects me is my friend.  I hope  this newly rediscovered research helps your thinking about how low/no stomach acid could be causing some of your GI problems forum members/friends.

We are all trying to find something that works for us and why we participate to share on this forum to help others with the same help knowledge we have gained on our way/journey God being our help.

2 Corinthians (KJV) 1:3,4  3) “Blessed be God, even the Father of our Lord Jesus Christ, the Father of mercies, and the God of all comfort; 4) who comforteth us in all our tribulation, that we may be able to comfort them which are in any trouble (starfish), by the comfort wherewith we ourselves are comforted of God.”

Posterboy by the grace of God,

 

 

[trents]

What's interesting to me is that the hypo acidity is linked to dermatitis herpetiformis but not villous atrophy. That is if I understood it correctly.

[cyclinglady]

Well, I have Chronic Autoimmune Gastritis.    However, it is not linked to my celiac disease.  I just had a recent endoscopy  which revealed my CAG, but my intestinal villi were completely healed.  

 This study is pretty old, so while there  might be a connection with DH, I think the link  may be that you can have many autoimmune disorders at the same time and perhaps the presentation or cells attacked might be more comparable.  I do have Hashimoto’s too.  But with autoimmune disorders so much is unknown.  

Nice to maybe improve or increase/decrease stomach acid, but better to find out the cause, be H. pylori, autoimmine, etc.  Why do so  many people suffer from gastritis?  Most have had a H. Pylori infection which is really common.  If I recall, about 2/3 of the population has it.    This type of gastritis can be treated and cured with antibiotics.  No need to use “band aids” on this type of gastritis.  

If anyone stomach issues despite being on a gluten-free diet, do not assume it is celiac disease as the root cause.    Get it checked out.  The best way to determine Chronic Autoimmune Gastritis is to get a biopsy.  

Open Original Shared Link

[Posterboy]

Cycylinglady and Trents,

I was hoping someone knew where the free citation for the full paper was but couldn't find it.

I did find after posting this research a much more modern and updated research on essentially the same topic in it's full citation entitled "Chronic Gastritis in Dermatitis Herpetiformis: A Controlled Study" edited by Fasano so I think it would be the gold standard.. . . or as close as we can get.

see this link

Open Original Shared Link

And what I got out of the study was a little/low stomach acid provided some protection -- No stomach acid provided no protection.

The original research math didn't match up to me (so I wanted to see the full citation.

quoting

"The frequency of achlorhydria was significantly higher in patients with dermatitis herpetiformis than in 69 patients with coeliac disease." but they started with 116 in their study.

quoting

"Gastric acid secretory capacity was evaluated in 116 patients with dermatitis herpetiformis by means of the pentagastrin test." they must mean both celiac's (without DH) and those with DH totaled 116. . but only the 69 with DH showed high correlation to no stomach acid (achlorhydria).

But back to the more modern study edited by Fasano. .. they concluded in my opinion a similar finding.

quoting there conclusion from the Fasano modern/updated study

"The present controlled study showed that patients with DH have at the time of the diagnosis a significantly increased frequency of CAG in the corpus but not in the antrum. In addition to H. pylori infection, autoimmune mechanisms may be implicated in the development of gastritis. The DH patients here did not present with any specific gastrointestinal symptoms."

Again here is the link to the modern study so as not confuse the studies.

Open Original Shared Link

They found simliar "Antrum sparing CAG" which is significant.

If you look at the chronic gastritis study.

Linked here again for convenience

Open Original Shared Link

they say "The first appearances of gastritis of the H. pylori etiology tend to be antral, i.e., gastritis is “antral predominant” [25, 27]." so in someone who does not have H. Pylori with the CAG then you would expect it to "spare the antrum" or be free of gastritis in the that part of the stomach at least initially as the stomach acid is only low at that point.

But if it continues to go down to/a the practically NO stomach acid level then you would expect the DH rate to increase with the stomach (no stomach) acid rate or lack there of in this case . . . if it is (GAC) not triggered by H. Pylori or if stomach acid helps control the auto-immune gastritis.

Of course this is before H. Pyori completely takes over the stomach.

quoting again.

"The most aggressive forms of chronic gastritis are those which result most likely in advanced stages of atrophic gastritis, i.e., are forms of H. pylori gastritis with highest likelihood to progress to the end-stage atrophy [5, 6]."

I have found like lisas11lisa “says research is your/our friend!”

the H.pylori infection itself can be limited in it's damage to the stomach lining until it directly affects stomach acid production by way of "end stage atrophy".

it is only when it spreads to the whole stomach including the "antrum" that cancer risks significantly jump up.

quoting

"The likelihood of gastric cancer in gastritis rises exponentially with the progression of the H. pylori gastritis from a non-atrophic form to an atrophic form [69]. The risk may rise even to 90-fold in patients with severe atrophic gastritis in both antrum and corpus (severe panatrophy; multifocal atrophic gastritis (MAG)) compared to the cancer risk in subjects with a normal and healthy stomach mucosa (Figure 7) [69]."

the good news if H. Pylori is triggering chronic auto-immune gastritis (CAG) then

treating the H.Pylori itself essentially controls the stomach cancer risk from CAG.

quoting again.

"A successful eradication of the H. pylori prevents ulcer recurrences but may also prevent cancers [66, 67]."

Trents I think the reason the Villous Atrophy did not correspond is that DH patients typically present with fewer GI symptoms.

they note this in the updated modern study.

quoting from the introduction

"The majority of patients with dermatitis herpetiformis (DH) evince small-bowel mucosal damage or inflammation similar to that in classic or early-stage celiac disease [1, 2]. (DH) Patients rarely suffer from abdominal symptoms, and irrespective of small-bowel mucosal morphology,  . . ."

And the reason for that is symptom's do not correspond (often) to the degree of Villous Atrophy.

See this study from the gluten free works website that talks about this very topic.

Open Original Shared Link

quoting gluten free works

"The pathologic range of villous atrophy seen on small intestinal biopsies ranges from severe (total villous atrophy and subtotal villous atrophy) to milder, partial villous atrophy.

The investigators state, “It would appear intuitive that the more severe forms of intestinal damage are correlated with the more severe and dramatic presentations.” With this in mind, one would think that those with total villous atrophy would experience more severe digestive symptoms like diarrhea. However, their study of medical records of all patients who had biopsy-proven celiac disease did not bear this out.

“Atypical, or silent, mode of presentation included anemia, osteoporosis, dermatitis herpetiformis, screening high risk groups and those detected incidentally at endoscopy performed for reasons apart from diarrhea or iron deficiency anemia.” 

It is important to note that “biopsies of the entire length of the small intestine, terminal ileal biopsies taken at colonoscopy and more recently video capsule colonscopy, reveal that the whole length of the intestine, including the large intestine, may be involved in the inflammatory process.”

And let's not forget the Villious atrophy can be patchy.

But if CAG and/or low/no stomach acid triggering CAG is common in Celiac disease then it makes sense to me . . . if my stomach is showing signs of atrophy then my/the villi in the small intestine would too.

I hope this is helpful.

*****this is not medical advice only the way I read this particular research. . . but I see them being linked conditions and not only associated conditions.

A follow up test/study needs to be done to see if correcting the stomach acid level to more robust  normal healthy level can/would then cause the villi to heal needs to be done.

Currently because the test for stomach acid is considered invasive . . .it is commonly not performed.

there is a Calcium Carbonate non-invasive breath test for Stomach acid that has been developed but it still considered experimental and not in wide use as I understand it.

Open Original Shared Link

here is  the abstract

The Calcium Carbonate Breath Test, a noninvasive test of stimulated gastric acid secretion: preliminary communication

Clough, Michael R.I.; Axon, Anthony T.R.

European Journal of Gastroenterology & Hepatology: Open Original Shared Link

doi: 10.1097/MEG.0b013e328321837e

Original Articles: Upper Gastrointestinal Disorders

 

• Open Original Shared Link
• Open Original Shared Link

"Background Gastric acid secretion is subject to complex control mechanisms, and varies widely between individuals and populations. Its measurement has previously required intubation of the stomach with ingestion of a test meal or injection of a secretion stimulant.

Aim We describe a novel method of measuring gastric acid secretion noninvasively – the Calcium Carbonate Breath Test.

Methods ¹³C-labelled calcium carbonate is ingested by a fasting participant. The carbonate neutralizes gastric acid to produce ¹³CO₂, which is expired in the breath. Measurement of the excess ¹³CO₂ in the breath allows back-calculation of the amount of gastric acid secreted during the test, provided that other variables affecting CO₂ production and excretion are minimized or controlled for.

Results Studies on a single healthy individual have shown reproducible estimations of acid secretion and over 80% suppression of acid secretion after the proton pump inhibitor treatment.

Conclusion The method seems to be promising, but further studies on other individuals need to be carried out. The Calcium Carbonate Breath Test may have wide applications in epidemiological studies, clinical management of acid-related diseases, screening for hypochlorhydria and development of new acid-suppressing treatments."

It is me again.

Once this test Calcium Carbonate Breath Test for Stomach acid/ pH strength becomes widely available like the Urea Breath Test for H.Pylori

Open Original Shared Link

These conditions can be comfortably measured in a clinical setting until then/because most people don't like having a tube down their noses to get officially tested to see how strong their stomach acid really is. . . most people are never tested to see if low stomach is the cause of CAG or related to their Celiac diagnosis.

I hope this is helpful and again this is not medical advice but this research was particularly interesting too me because both the stomach acid levels and Celiac/DH was studied in the same person.

this set's precedent . . . but does not establish a causal relationship but certainly establishes casual association.  And it is worth more research/study to see if it causal.

But the high prevalence of  achlorhydria (No stomach acid) in DH patients would make me want to investigate it further with my doctor.

Sorry for the long post/reply but I had a lot of ground to cover.

as always 2 Timothy 2: 7   “Consider what I say; and the Lord give thee understanding in all things” this included

I only know treating my low stomach acid helped many of my GI problems.

It did not directly help my low nutrient levels until I supplemented with the missing nutrients my stomach/small intestine could now absorb again. . . like Magnesium, Vitamin D, Zinc and a good B-Complex etc.

see this link for appropriate supplementation in Celiacs.

Open Original Shared Link

Again I hope this is helpful and it will help some one else by the same help I found God being my help.

2 Corinthians 1: 3, 4

³ Blessed be God, even the Father of our Lord Jesus Christ, the Father of mercies, and the God of all comfort;

⁴ Who comforteth us in all our tribulation, that we may be able to comfort them which are in any trouble, by the comfort wherewith we ourselves are comforted of God.

Good luck on your continued journey! The road not taken (differential diagnosis) of Low/No stomach acid misdiagnosed (or at least the concomitant condition) of achlorhydria and hypochlorydria can trigger some very similar conditions like CAG that occur in Celiac's often (I believe). . .and until you treat the one you won't know if it is causing your many symptom's you might still be having after going gluten free.

As cyclinglady said quoting

"If anyone (is having (my words added for clarity)) stomach issues despite being on a gluten-free diet, do not assume it is celiac disease as the root cause.    Get it checked out."

Posterboy by the grace of God,