Dr. Matt and Dr. Mike's Medical Podcast Stomach Acid Regulation and Drugs
Oct 25, 2025
The discussion delves into the anatomy of the stomach and the various gastric cell types that play crucial roles in acid secretion. Listeners learn how parietal cells produce hydrochloric acid through fascinating biochemical processes. They explore different regulatory mechanisms affecting stomach acid, including local and cephalic controls. The talk also covers the class of drugs used to manage acid levels, such as antacids and proton pump inhibitors, and highlights the significance of Helicobacter pylori in gastritis and ulcers.
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How Parietal Cells Make Stomach Acid
- Parietal cells use a hydrogen-potassium ATPase to secrete H+ while exchanging K+ and trafficking Cl- to form HCl in the canaliculi.
- Bicarbonate exits basolaterally creating an alkaline tide that offsets acid secretion.
Local Gastric Control Dominates Acid Output
- Gastric regulation (local enteric reflexes) provides about 60% of acid control, relying on gastrin and histamine to stimulate parietal cells.
- Enteric acetylcholine, gastrin from G cells, and ECL-cell histamine integrate to determine acid output.
Cephalic Phase Strongly Stimulates Acid
- The cephalic phase (sight, smell, taste of food) accounts for roughly 30% of acid secretion through vagal activation.
- Anticipation and sensory cues trigger vagal efferents that boost acid via the enteric system.
