Gastric Acidity in Older Adults

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Abstract
Context. —Early studies suggested that gastric acidity declines as people age. However, sequelae of achlorhydria are uncommon in older people, making this conventional wisdom unlikely. Objective. —To ascertain the prevalence of basal gastric acidity and atrophic gastritis (indicated by serum pepsinogen ratio) in older adults. Design. —Cross-sectional study in a volunteer sample. Setting. —Retirement communities in suburbs of Kansas City, Mo. Subjects. —A total of 248 white male and female volunteers aged 65 years or older living independently. Main Outcome Measures. —Presence of basal unstimulated gastric acid was evaluated noninvasively by having subjects swallow quininium resin. Gastric acid with a pH lower than 3.5 releases quinine, which is then absorbed and excreted into urine. Atrophic gastritis was defined as a ratio of serum pepsinogen l/pepsinogen II of less than 2.9. Results. —Basal unstimulated gastric content was acidic (pH P<.001). Conclusions. —In contrast to what is commonly stated, nearly 90% of elderly people in this study were able to acidify gastric contents, even in the basal, unstimulated state. Of those who were consistent hyposecretors of acid, most had serum markers of atrophic gastritis.