Gastric acid secretion and enteric infection in Bangladesh

Abstract

In developing countries many enteric infections are caused by acid-sensitive pathogens. Failure of the gastric acid barrier to infection has been reported in cholera but gastric acid secretion has been little studied in other enteric infections. We therefore studied basal and stimulated gastric acid in 185 Bangladeshi men admitted to hospital for the treatment of enteric infection. Patients with dysentery (amoebiasis, n=24 and shigellosis, n= 19) and culture-negative diarrhoea (n=69) had similar mean gastric acid levels (basal, 3-5 mmol/h; stimulated, 11-17 mmol/h), which remained stable in those patients studied throughout 12 weeks of convalescence. In contrast, patients with secretory diarrhoea caused by cholera or enterotoxigenic Escherichia coli (ETEC) had low gastric acid levels (P<O.05 compared with other groups) (cholera, n=34: basal mean 1·8 mmol/h [SD=2·2], stimulated mean 7·9 mmol/h [SD=6·4]; ETEC, n=39: basal mean 2·7 mmol/h [SD=2·8], stimulated mean 9·4 mmol/h [SD=7·5]). Cholera patients' gastric acid level rose during convalescence to similar levels to the dysentery patients'. Low gastric acid level was associated with severe disease in patients with cholera (P<0·02) or ETEC (P<0·05). Gastric acid level fell with increasing age (P<0·007) but this did not account for the differences between groups. Gastric acid levels were not associated with Giardia duodenalis or Strongyloides stercoralis co-infection, fever, use of tobacco, or chewing betel nut. Cholera and secretory diarrhoea caused by ETEC may, therefore, partly result from a reduction in gastric acid level which does not occur during dysentery. Factors which impair gastric acid secretion may predispose to diarrhoeal disease in developing countries.

Systematic review: the use of proton pump inhibitors and increased susceptibility to enteric infection

“…V. cholerae , the cause of cholera and an important cause of dehydrating diarrhoea in endemic areas of the developing countries, is very acid sensitive 66 . Studies have provided evidence that those experiencing cholera in endemic areas are preselected based on their reduced basal gastric hydrochloric acid 67–69 .…”

Adverse Effects of Long-Term Proton Pump Inhibitor Therapy

“…Unlike Campylobacter and Salmonella, Shigella is an acidresistant organism; hence patients with reduced gastric acidity have not been known to be at increased risk of Shigella infection [105]. There is no known association between PPI use and increased risk of Listeria infection, although human listeriosis has been associated with antacid and H2 blocker use in a retrospective case-control study of inpatients using these agents during an outbreak of hospital-acquired listeriosis [106].…”

Acute Helicobacter pylori Infection Is Followed by an Increase in Diarrheal Disease Among Peruvian Children

“…50 Although resistance to gastric acid among Escherichia coli is probably strain-specific, 51,52 the infectious dose of enterotoxigenic E coli infection is decreased among hypochlorhydric persons. [53][54][55] Other acid-sensitive organisms that might preferentially cause diarrhea in people with hypochlorhydria include rotavirus and other enteric viruses, 56 -58 Brucella spp., 59 and Giardia lamblia. 42 Although not proven, it is therefore plausible that temporary loss of the gastric acid barrier could mediate the observed association between H pylori and diarrheal disease, because H pylori-induced hypochlorhydria has been observed after acute infection in adults.…”