Gastric acid is a fluid with a pH value between 1.5 and 3.5 that aids digestion. It is mainly composed of hydrochloric acid, potassium chloride, and sodium chloride. Gastric acid is produced by the lining cells of the stomach, which are called parietal cells, and its role is to aid the digestion of proteins because it prepares longer amino acid molecules to make it easier for the enzymes to break them down. However, several disorders can affect the physiological mechanisms of gastric acid production and cause disorders, and elderly patients are at higher risk than other age groups.
There are three stages in addition to the basal phase when it comes to gastric acid secretion (Huether, S. E., McCance, K. L., (2012). In the cephalic phase, the cells secrete 30 percent of the available gastric acid, and that process is encouraged by smelling or anticipating food. In the gastric phase, the acid is stimulated by the amino acids and the stomach’s distension, and the release reaches 50 percent of total volume. Finally, in the intestinal phase, the rest of the gastric acid is released when the partially digested food enters the small intestine. When people are not eating, a small amount of gastric acid is still being produced and present constantly, and that is referred to as the basal phase. The regulation of gastric acid occurs in the parasympathetic nervous system, and gastrin stimulates its production while several other hormones inhibit it.
Several disorders, such as peptic ulcer disease (PUD), gastritis, and gastroesophageal reflux disease (GERD), can impact the normal physiological processes of secreting gastric acid. Peptic ulcers occur on the mucous membrane of the stomach or duodenum. The superficial mucosa is responsible for protecting the stomach and duodenum from the gastric acid, so when the defensive mechanisms are impaired, damage to the tissue occurs. Peptic ulcers in the duodenum may impair the secretion of bicarbonate, which is essential for neutralizing the acid before it enters the small intestine.
GERD is caused by decreased motility in the esophagus, which results in poor acidic clearance. Several causes, including lower esophageal sphincter dysfunctions, delayed gastric emptying, and hiatal hernia, were associated with acid reflux because they represent malfunctions in the defensive mechanisms that prevent acid build-up and mucosal injury. Gastritis is a common condition, and it is often caused by Helicobacter pylori bacteria. H. pylori is the most common primary cause of gastritis, but the bacteria has the opportunity to infect the host only when hypochlorhydria and achlorhydria impair the secretion of gastric acid, thus decreasing the disinfection of the gastric mucosa.
The epidemiology and treatment of those conditions mainly depends on the age of the patients. For example, the chances of H. pylori infections increases with age, and 75 percent of elderly patients are estimated to suffer from gastritis (Gomaa, Hassan, Sawy, Ahmed, & Metwally, 2012). With that in mind, the main objective is to treat the infection with medication. Amoxicillin, bismuth, and metronidazole are effective in treating gastritis in all age groups, but the dosages should often be stronger for adults, and children should not receive compounds containing salicylate. In elderly patients who suffer from GERD, proton pump inhibitors are the main causes and require treatment. Treating the proton pump inhibitors is considered a safe long-term therapy, but anti-reflux surgery may also be safe and effective in elderly patients with GERD (Poh, Navarro-Rodriguez, & Fass, 2010). Finally, peptic ulcers have high-mortality rates in all age groups, but the elderly are particularly at risk because of stronger internal bleeding (Kemppainen, Räihä, & Sourander, 2009), so bleeding regulation should be addressed while treating the primary cause in all age groups.
Figure 1. Gastritis mind map.
References
Gomaa, S. I., Hassan, A., El Sawy, M. M., Ahmed, E. A. Z., & Metwally, M. (2012). Relation between Helicobacter pylori and atrophic gastritis in elderly: Estimation of serum (gastrin 17 and pepsinogen-I) as novel biomarkers. Alexandria Journal of Medicine, 48, 289-294.
Huether, S. E., McCance, K. L., (2012). Understanding pathophysiology (5th ed.). Philidelphia, PA: Elsevier Science Health Science Division.
Kemppainen, H., Räihä, I., & Sourander, L. (2009). Clinical presentation of peptic ulcer in the elderly. Gerontology, 43(5), 283-288.
Poh, C. H., Navarro-Rodriguez, T., & Fass, R. (2010). Review: Treatment of gastroesophageal reflux disease in the elderly. The American Journal of Medicine, 123(6), 496-501.
