Prevalence of achlorhydria in an Asian population detected using Congo red staining during routine gastroscopy: 22 years' experience from a single centre

BMJ Open Gastroenterol. 2022 Aug;9(1):e000976. doi: 10.1136/bmjgast-2022-000976.


Objective: We aimed to study the prevalence of achlorhydria (AC) in a large Asian population.

Design: Medical records of patients who underwent oesophagogastroduodenoscopy (OGD) with Congo red staining method at the Vichaiyut Hospital from January 2010 to December 2019 were retrospectively reviewed.

Results: A total of 3597 patients was recruited; 223 were excluded due to concurrent use of proton pump inhibitors. Eighteen from 3374 patients (0.53%) had AC. Seven patients were presented with permanent AC (5F, 2M) (median age=69 years; range 58-92). Among 11 patients with temporary AC (5M, 6F: mean age 73.4 years; SD 13.2 years), all had gastrointestinal Helicobacter pylori bacterial infection and were over 45 years old. After successful treatment for H. pylori, AC was absent among patients with temporary AC. If counting only patients over 45 years of age, the prevalence of AC was 0.68% (18/2614). No adverse events arising from Congo red occurred.

Conclusion: AC is relatively rare. Permanent and temporary AC were found only when they were over 55 and 45 years old, respectively. Staining Congo red on gastric mucosa can be safely and routinely incorporated into the OGD procedure for early detection of AC. We recommended a low-cost screening test such as serum vitamin B levels for screening only in patients aged 50 and over.

Keywords: anemia; endoscopy; gastric acid secretion; gastrointesinal endoscopy.

MeSH terms

  • Achlorhydria* / diagnosis
  • Aged
  • Aged, 80 and over
  • Congo Red
  • Gastroscopy
  • Helicobacter Infections* / diagnosis
  • Helicobacter Infections* / epidemiology
  • Helicobacter Infections* / microbiology
  • Helicobacter pylori*
  • Humans
  • Middle Aged
  • Prevalence
  • Retrospective Studies
  • Staining and Labeling


  • Congo Red