{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,14]],"date-time":"2026-10-14T12:42:02Z","timestamp":1791981722102,"version":"4.4.0"},"reference-count":215,"publisher":"MDPI AG","issue":"23","license":[{"start":{"date-parts":[[2019,11,29]],"date-time":"2019-11-29T00:00:00Z","timestamp":1574985600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["IJMS"],"abstract":"<jats:p>Gastric juice is a unique combination of hydrochloric acid (HCl), lipase, and pepsin. Acidic gastric juice is found in all vertebrates, and its main function is to inactivate microorganisms. The phylogenetic preservation of this energy-consuming and, at times, hazardous function (acid-related diseases) reflects its biological importance. Proton pump inhibitors (PPIs) are one of the most widely used drugs in the world. Due to the reduced prevalence of Helicobacter pylori infection as well as the increased use of inhibitors of gastric acid secretion, the latter has become the most important cause of gastric hypoacidity. In the present manuscript, we review the microbiological consequences of removing gastric acidity. The resulting susceptibility to infections has not been studied extensively, and focus has mainly been restricted to bacterial and parasitic agents only. The strongest evidence concerning the relationship between hypochlorhydria and predisposition to infections relates to bacterial infections affecting the gastrointestinal tract. However, several other clinical settings with increased susceptibility to infections due to inhibited gastric acidity are discussed. We also discuss the impact of hypochlorhydria on the gut microbiome.<\/jats:p>","DOI":"10.3390\/ijms20236031","type":"journal-article","created":{"date-parts":[[2019,11,29]],"date-time":"2019-11-29T10:58:21Z","timestamp":1575025101000},"page":"6031","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":90,"title":["The Phylogeny and Biological Function of Gastric Juice\u2014Microbiological Consequences of Removing Gastric Acid"],"prefix":"10.3390","volume":"20","author":[{"given":"Tom C.","family":"Martinsen","sequence":"first","affiliation":[{"name":"Department of Clinical and Molecular Medicine, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology (NTNU), 7006 Trondheim, Norway"},{"name":"Department of Gastroenterology and Hepatology, Clinic of Internal Medicine, St Olav\u2019s Hospital\u2014Trondheim University Hospital, 7006 Trondheim, Norway"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5365-9357","authenticated-orcid":false,"given":"Reidar","family":"Fossmark","sequence":"additional","affiliation":[{"name":"Department of Clinical and Molecular Medicine, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology (NTNU), 7006 Trondheim, Norway"},{"name":"Department of Gastroenterology and Hepatology, Clinic of Internal Medicine, St Olav\u2019s Hospital\u2014Trondheim University Hospital, 7006 Trondheim, Norway"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3137-0843","authenticated-orcid":false,"given":"Helge L.","family":"Waldum","sequence":"additional","affiliation":[{"name":"Department of Clinical and Molecular Medicine, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology (NTNU), 7006 Trondheim, Norway"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2019,11,29]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"987","DOI":"10.1136\/gut.33.7.987","article-title":"Non-immunological defence mechanisms of the gut","volume":"33","author":"Sarker","year":"1992","journal-title":"Gut"},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"373","DOI":"10.1097\/00000441-192503000-00008","article-title":"The gastric secretion: Its bactericidal value to man","volume":"169","author":"Bartle","year":"1925","journal-title":"Am. 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