This is a common condition in the elderly which comes from the inability to secrete sufficient stomach acid to kill bacteria. Ingested bacteria can thus survive and reside in the stomach and the upper part of the small bowel. This problem affects approximately 20% of people between 60 and 69 years of age, and 40% of people over 80.
These bacteria, which are not killed by the normal stomach acid, interfere with the absorption of vitamin B12. Putting these patients on antibiotics to reduce the number of bacteria returns their B12 levels to normal. The author notes that the deficiency of vitamin B12 may not be severe enough to show up in the blood, but it can be associated with psychiatric dementias. These deficiencies may be disguised as Alzheimer’s disease or senile dementia.
Atrophic gastritis is characterized by atrophy of the stomach wall with reduced or absent gastric acid secretion. It may also lead to reduced levels of intrinsic factor.A significant number of elderly people have atrophic gastritis with hypo- or achlorhydria, predisposing them to bacterial overgrowth. A study showed that elderly atrophic gastritis subjects are more easily populated with specific lactobacilli than normal subjects. This study also showed that organisms found in yogurt have no impact on the flora of healthy elderly subjects and a relatively small impact on elderly atrophic gastritis subjects.
Lactobacillus gasseri was the only one among several organisms administered that was successfully implanted in healthy and atrophic gastritis individuals.
Signs, symptoms & indicators of Atrophic Gastritis
Weak appetite
Meal-related bloating
Unexplained nausea
Conditions that suggest Atrophic Gastritis
Hydrochloric Acid Deficiency
The ability to produce acid, pepsin and intrinsic factor is lost altogether in patients with complete gastric atrophy.
Edema (Water Retention)
Edema may be due to low levels of circulating proteins from poor protein digestion.
Rheumatoid Arthritis
Chronic atrophic gastritis occurs in up to 63% of rheumatoid arthritis patients. Achlorhydria also occurs frequently and is associated with changes in gastric microbial patterns.
Osteoporosis / Risk
Stomach acid is required to enhance the absorption of minerals such as calcium. Reduced calcium absorption encourages bone loss.
Zinc Requirement
Those with atrophic gastritis, vagotomy or gastric resection may be at increased risk for zinc deficiency.
Not having atrophic gastritis
Risk factors for Atrophic Gastritis
Anemia, Megaloblastic
Gastric autoimmune disease has been classified into types A and B, based on the changes in different portions of the stomach. Patients with antibodies to parietal cells (PCA) or intrinsic factor, or both, have atrophy of the fundal mucosa (Type A) and a very high rate of pernicious anemia, often associated with other autoimmune endocrine disorders. In cases of Type B gastritis, PCA are lacking and there is no association with pernicious anemia or other autoimmune endocrine disorders.
Recent unexplained weight loss
Atrophic Gastritis can lead to
Rheumatoid Arthritis
Chronic atrophic gastritis occurs in up to 63% of rheumatoid arthritis patients. Achlorhydria also occurs frequently and is associated with changes in gastric microbial patterns.
Increased Risk of Stomach Cancer
Gastric cancer is 5 to 10 times more likely in those with chronic atrophic gastritis; the same increased incidence is also found in first-degree relatives of patients with gastric cancer and pernicious anemia.
Recommendations for Atrophic Gastritis
Iron
Ferric iron absorption is decreased in achlorhydria but heme iron absorption is not.
Vitamin C (Ascorbic Acid)
There may be a localized deficiency of Vitamin C in atrophic gastritis. Recent evidence suggests that beta-carotene and/or vitamin C along with vitamin E may reverse or reduce the risk of atrophic gastritis and/or gastric cancer. Another study showed vitamin C levels to be low in atrophic gastritis and Helicobacter Pylori infection.
Key
| Weak or unproven link |
| Strong or generally accepted link |
| Proven definite or direct link |
| Very strongly or absolutely counter-indicative |
| May do some good |
| Likely to help |
| Highly recommended |
Glossary
Stomach
A hollow, muscular, J-shaped pouch located in the upper part of the abdomen to the left of the midline. The upper end (fundus) is large and dome-shaped; the area just below the fundus is called the body of the stomach. The fundus and the body are often referred to as the cardiac portion of the stomach. The lower (pyloric) portion curves downward and to the right and includes the antrum and the pylorus. The function of the stomach is to begin digestion by physically breaking down food received from the esophagus. The tissues of the stomach wall are composed of three types of muscle fibers: circular, longitudinal and oblique. These fibers create structural elasticity and contractibility, both of which are needed for digestion. The stomach mucosa contains cells which secrete hydrochloric acid and this in turn activates the other gastric enzymes pepsin and rennin. To protect itself from being destroyed by its own enzymes, the stomach’s mucous lining must constantly regenerate itself.
Bacteria
Microscopic germs. Some bacteria are "harmful" and can cause disease, while other "friendly" bacteria protect the body from harmful invading organisms.
Cobalamin
Vitamin B-12. Essential for normal growth and functioning of all body cells, especially those of bone marrow (red blood cell formation), gastrointestinal tract and nervous system, it prevents pernicious anemia and plays a crucial part in the reproduction of every cell of the body i.e. synthesis of genetic material (DNA).
Alzheimer's Disease
A progressive disease of the middle-aged and elderly, characterized by loss of function and death of nerve cells in several areas of the brain, leading to loss of mental functions such as memory and learning. Alzheimer's disease is the most common cause of dementia.
Dementia
An acquired progressive impairment of intellectual function. Marked compromise exists in at least three of the following mental activity spheres: memory, language, personality, visuospatial skills, and cognition (i.e., abstraction and calculation).
Atrophic Gastritis
Chronic inflammation of the stomach that causes the breakdown of the mucous membranes and a reduction in the number of functioning stomach cells. Seen mainly in the elderly.
Gastritis
Inflammation of the stomach lining. White blood cells move into the wall of the stomach as a response to some type of injury; this does not mean that there is an ulcer or cancer - it is simply inflammation, either acute or chronic. Symptoms depend on how acute it is and how long it has been present. In the acute phase, there may be pain in the upper abdomen, nausea and vomiting. In the chronic phase, the pain may be dull and there may be loss of appetite with a feeling of fullness after only a few bites of food. Very often, there are no symptoms at all. If the pain is severe, there may be an ulcer as well as gastritis.
Achlorhydria
The complete absence or failure of stomach acid secretion.
Edema
Abnormal accumulation of fluids within tissues resulting in swelling.
Protein
Compounds composed of hydrogen, oxygen, and nitrogen present in the body and in foods that form complex combinations of amino acids. Protein is essential for life and is used for growth and repair. Foods that supply the body with protein include animal products, grains, legumes, and vegetables. Proteins from animal sources contain the essential amino acids. Proteins are changed to amino acids in the body.
Chronic
Usually Chronic illness: Illness extending over a long period of time.
Rheumatoid Arthritis
A long-term, destructive connective tissue disease that results from the body rejecting its own tissue cells (autoimmune reaction).
Mineral
Plays a vital role in regulating many body functions. They act as catalysts in nerve response, muscle contraction and the metabolism of nutrients in foods. They regulate electrolyte balance and hormonal production, and they strengthen skeletal structures.
Calcium
The body's most abundant mineral. Its primary function is to help build and maintain bones and teeth. Calcium is also important to heart health, nerves, muscles and skin. Calcium helps control blood acid-alkaline balance, plays a role in cell division, muscle growth and iron utilization, activates certain enzymes, and helps transport nutrients through cell membranes. Calcium also forms a cellular cement called ground substance that helps hold cells and tissues together.
Zinc
An essential trace mineral. The functions of zinc are enzymatic. There are over 70 metalloenzymes known to require zinc for their functions. The main biochemicals in which zinc has been found to be necessary include: enzymes and enzymatic function, protein synthesis and carbohydrate metabolism. Zinc is a constituent of insulin and male reproductive fluid. Zinc is necessary for the proper metabolism of alcohol, to get rid of the lactic acid that builds up in working muscles and to transfer it to the lungs. Zinc is involved in the health of the immune system, assists vitamin A utilization and is involved in the formation of bone and teeth.
Autoimmune Disease
One of a large group of diseases in which the immune system turns against the body's own cells, tissues and organs, leading to chronic and often deadly conditions. Examples include multiple sclerosis, rheumatoid arthritis, systemic lupus, Bright's disease and diabetes.
Antibody
A type of serum protein (globulin) synthesized by white blood cells of the lymphoid type in response to an antigenic (foreign substance) stimulus. Antibodies are complex substances formed to neutralize or destroy these antigens in the blood. Antibody activity normally fights infection but can be damaging in allergies and a group of diseases that are called autoimmune diseases.
Mucosa
Mucous tissue layer lining tubular structures (nasal passages, ear canal, etc.).
Pernicious Anemia
Anemia caused by a vitamin B12 deficiency.
Anemia
A condition resulting from an unusually low number of red blood cells or too little hemoglobin in the red blood cells. The most common type is iron-deficiency anemia in which the red blood cells are reduced in size and number, and hemoglobin levels are low. Clinical symptoms include shortness of breath, lethargy and heart palpitations.
Cancer
Refers to the various types of malignant neoplasms that contain cells growing out of control and invading adjacent tissues, which may metastasize to distant tissues.