Low gastric acid as a rise factor for cholera transmission: Application of a new non-invasive gastric acid field test

Although gastric acid is thought to be an important host defense against certain enteric infections, field studies of the role of gastric acid in preventing enteric infections have been hampered by the lack of a suitable non-invasive test. Because low gastric acid output (GAO) is an established risk factor for cholera, we assessed after validation, whether a new non-invasive test which estimates GAO by measuring breath hydrogen excess after ingestion of magnesium and a stimulant of gastric acid secretion, could discriminate between persons at high and at low risk of developing cholera. Fifteen age-matched pairs, participants in, the field trial of two oral cholera vaccines in rural Bangladesh, were tested. In each pair the “case” was a person who had recovered from severe cholera at least 6 months before testing and the “control” was a person who resided in the home of a cholera patient but remained uninfected. The stimulated breath hydrogen was higher in controls (median hydrogen EXCESS = 369 μmol/80 min) than in cases (median hydrogen EXCESS = 150 μmol/80 min) (p < 0.05) and was higher in controls in 12 out of 15 pairs. The results, which are consistent with past invasive assessments of the association between hypochlorhydrid and cholera, suggest that this non-invasive test may be useful in evaluating GAO in epidemiological field studies.