Acidity: A cause for heartburn

Jai, after skipping lunch to finish his project on time, goes out for dinner with friends. Along with good company, he thoroughly enjoys the rich (spicy and fried) food, a few drinks and after-meal smoke. He goes home and immediately heads for his bed but wakes up 30 minutes later feeling queasy and nauseous with a sour taste in his mouth. He heads to the kitchen, pours himself a glass of water, mixes in a sachet of antacid and gulps down the concoction. Jai's inconvenient acidity problem is resolved within minutes and he is fast asleep again.

If the above episode was a once-in-a-few-months occurrence there would be little cause for concern. But regular episodes of acidity signal more serious conditions that may impact a person's quality of life. It is difficult to estimate the prevalence of acidity because of the high usage of over-the counter (OTC) anti-acidity medications.

Multiple terms are used interchangeably to describe varying, but related, digestion or gastrointestinal (GI) conditions: acidity, heartburn, indigestion, hyperacidity, dyspepsia, acid reflux, peptic ulcer, and gastro-esophageal reflux disease (GERD). The table below illustrates how these conditions are related:

The term acidity or hyperacidity in particular refers to a condition in which the stomach's glands overproduce gastric acid - the major component being hydrochloric acid which is necessary for normal food digestion. This overproduction of acid may occur as a consequence of stress, diet (especially spicy and non-vegetarian food), lifestyle (smoking, alcohol), peptic ulcers, GERD, stomach tumors or medications (in particular, non-steroidal anti-inflammatory drugs, NSAIDs).

The symptoms of acidity - after a meal - include restlessness, nausea, belching, sour taste, stiff stomach, indigestion and constipation.

Normally, the stomach and duodenum are protected from the corrosive effects of the gastric acid by natural bicarbonate and prostaglandins secreted in the mucous lining these neutralize the acid and dilate blood vessels for regular blood flow respectively. The breakdown in these defensive mechanisms leads to damaged stomach lining which causes bleeding and ulcers.

Often a patient presenting with acidity symptoms is treated with acid-neutralizing or acid-controlling medications. If the symptoms do not improve after 4 weeks, then several clinical tests may be performed for a more detailed diagnosis. Some of the tests include upper gastrointestinal endoscopy to identify ulcers or barium meal test for Zollinger-Ellison Syndrome or ulcer biopsy to detect tumors.

Regardless of the diagnosis, treatment includes changes in diet (avoid acidic foods including spicy and salty foods), lifestyle (no smoking and alcohol) and stress-reduction. Antacids are the first-line of defence and offer immediate symptom relief by neutralising excess acid. Antacids contain either magnesium or calcium or aluminium containing compounds. Histamine blocking agents (H2 receptor blockers) such as cimetidine, ranitidine, famotidine or nizatidine or proton pump inhibitors such as omeprazole and lansoprazole reduce the production of acid by the stomach. Rarely, surgery (vagotomy) is used to reduce the acid secretion.

Antacids and other medications are a quick fix for acidity but are not meant for long-term use. There are multiple home or non-medication remedies for reducing or inhibiting acidity. Some of the more well-known ones are:

• eat banana, watermelon, cucumber, yogurt, jaggery
• add ginger to all food items
• drink water, coconut-water, lemon juice, amla-juice, milk
• consume last meal a few hours before sleeping
• have small, regular meals
• chew tulsi leaves, cloves, saunf (aniseed) or chewing gum
• avoid pickles, spicy chutneys, vinegar
• reduce aerated (soft) drinks, smoking, alcohol

A common home-made antacid remedy is to consume a half glass of water with teaspoon of baking soda. There are also acidity-free or treat-acidity recipes that can be adopted in regular cooking e.g. cucumber plus curd rice.