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Acidity

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Dr. Santosh Palve
Gastroenterologist

verified

Acidity is a term used for a set of symptoms caused by the excess acid production by the stomach’s gastric glands. Normally, the stomach secretes HCl, which is necessary for the breakdown and digestion of food. Excess acid secretion causes symptoms such as dyspepsia, heartburn, gastric inflammation and stomach ulcers. Acidity affects both men and women of all ages and community, and hyperchlorhydria is the medical term for this condition.

Acidity is often used to describe a condition known as acid reflux. Under normal condition, the valve present at the end of our food pipe (oesophagus) closes after the food reaches the stomach. However, this valve does not close during acid reflux, resulting in the acid backflow from the stomach to the food pipe. As per the Montreal definition, gastro oesophageal reflux disease (GERD) is a condition of troublesome symptoms and complications caused by the reflux of stomach’s contents into the oesophagus.

GERD’s risk factors include old age, excessive body mass index (BMI), smoking, anxiety/depression, and less physical activity at work. Moreover, eating habits, such as the food-related acidity, as well as the size and timing of meals, particularly with respect to sleep, may contribute to GERD. Recreational physical activity appears to be protective except when post-prandially performed.

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Acidity is more in countries where individuals eat more of non-vegetarian, oily and spicy foods. Certain medications such as non-steroidal anti-inflammatory drugs (NSAIDs) predisposes individuals to gastric acidity.

Heartburn, which is a burning sensation in the chest that radiates toward the mouth because of acid reflux into the oesophagus, is the classic and most common symptom of GERD. However, only a small percentage of reflux events are symptomatic. Moreover, heartburn is often associated with a sour taste at the back of the mouth with or without the regurgitation of the refluxate.

Note that GERD is a common cause of non-cardiac chest pain. It is important to distinguish between the underlying cause of chest pain because of the potentially serious implications of cardiac chest pain and varied diagnostic and treatment algorithms based on aetiology. A good clinical history may elicit GERD symptoms in patients with non-cardiac chest pain, thus indicating GERD as a potential aetiology.

Acidity can be treated with antacids and primarily by making changes in eating and lifestyle habits. Endostism is a new technique and can provide relief from acid reflux. This section offers certain really good home remedies for acidity . Moreover, to reduce the acidity-related symptoms, you can read about the importance of having an alkaline diet.

Causes

Our stomach produces gastric acids to help digestion. However, their corrosive effects are neutralised by producing natural bicarbonate and prostaglandins secreted in the mucous lining. When the production of these chemicals is interrupted, it leads to damaged stomach lining, which causes acidity. Certain potential causes that can trigger acidity are listed below:

GERD occurs more commonly in people who are:


  1. Overweight or obese because of high pressure on the abdomen

  2. Pregnant because of the high abdominal pressure

  3. Taking certain medications, including certain asthma medications, Ca channel blockers, antihistamines, sedatives, and antidepressants

  4. Smoking and being exposed to second-hand smoke

  5. Consumption of excess tea or coffee

  6. Sedentary lifestyle

  7. Infection by Helicobacter pylori bacteria

  8. Going to bed immediately after a meal

Symptoms

The common signs and symptoms that you might experience are listed below:


  1. Burning in the stomach

  2. Burning in the throat

  3. Burning sensation in the chest 

  4. Restlessness

  5. Belching

  6. Nausea

  7. Sour taste

  8. Indigestion

  9. Constipation

  10. Cough not responding to treatment

  11. Asthmatic symptoms

Complications

If proper attention is not paid to acidity and it is left untreated, it can lead to complications such as gastric ulcers, gastric oesophagal reflux disease (GERD), duodenitis, irritable bowel syndrome, and peptic strictures.



  • Gastroesophageal reflux disease (GERD): GERD is suspected if acid reflux symptoms persist for more than three times a week or if it continues for several weeks. Proper medical attention is required for GERD or it can lead to more severe health conditions.

  • Gastric ulcers: When the excess acid damages the stomach or duodenum's lining, it leads to gastric ulcers. Surgery may be required if the ulcers do not heal with medications.

  • Oesophagal strictures: Over time, the backflow of acid from the stomach can damage the lining of the oesophagus, thus leading to strictures. Such strictures are known as peptic strictures, which can be both cancerous and non-cancerous. Strictures do not allow food and liquid to enter the stomach.

  • Oesophageal cancers: Adenocarcinoma and squamous cell carcinoma are the two types of cancer that occur in the oesophagus.

  • Duodenitis: Duodenitis is the inflammation of the first part of the small intestine.

Diagnosis

Usually, acidity and acid reflux is self-diagnosable by paying attention to one's symptoms and lifestyle habits. If medications and lifestyle changes do not provide relief from acidity/acid reflux symptoms, it usually indicates its complications. Complications such as gastroesophageal reflux disease (GERD) can be diagnosed with the help of the following examinations:

 


  • Upper GI endoscopy and biopsy: This helps to examine the lining of the oesophagus, stomach and duodenum. They may help in diagnosing the complications associated with GERD such as Barrett’s oesophagus, strictures and esophagitis.

  • Radiological Imaging: Moreover, X-rays can help visualise any problems associated with the upper gastrointestinal tract.

  • Oesophagal manometry: This test determines the ability of the oesophagal valve and muscles to help food pass from the oesophagus to the stomach.

  • Oesophageal pH monitoring: The acid amount that refluxes back from the stomach to the oesophagus is determined using this test. 

  • Serology and histology for H. pylori infection

Treatment

Usually, acidity is treated with the help of antacids that contain either Mg-, Ca- or Al-containing compounds. These antacids neutralise the excess acid in the stomach, thus providing symptomatic relief.

Complications such as GERD are treated with a combination of lifestyle modifications and pharmacological therapy such as proton pump inhibitors and H2 receptor antagonist. Surgery is required in severe cases where pharmacological therapy does not show any positive response.

Medication Options


Many drugs are available to treat GERD and its symptoms:

  • Antacids: These neutralize stomach acid and offer quick but mild relief. The overuse of antacids can cause side effects, including diarrhoea and kidney problems.

  • H2 receptor blockers: While they reduce acid production, they do not work as quickly as antacids but they do provide longer relief. These drugs may reduce acid production from the stomach for up to 12 h.

  • Proton pump inhibitors: They are known as PPIs as they effectively suppress stomach acid and help heal your oesophagus.


If you do not see much improvement with an OTC drug, your doctor may prescribe a prescription strength version of an H2 receptor blocker or PPI. Moreover, there is a medication called baclofen, which strengthens the lower oesophageal sphincter. 


For almost all the abovementioned acidity-related disorders, the treatment approach remains the same, including lifestyle modifications, antacids and surgery in extreme situations. If H. pylori infection is the cause of the disease, antibiotics are added to the treatment regimen. 


Surgery Options


If lifestyle changes and drugs are not enough to manage GERD, you may be a candidate for surgery. Surgical procedures to treat GERD are listed below:

  • Fundoplication: In this minimally invasive procedure, a surgeon sews the top of the stomach around the oesophagus, which adds pressure to the lower end of the oesophagus to prevent reflux.

  • LINX Device: Another minimally invasive procedure that involves a ring of small magnetic beads that are wrapped around the area where the stomach and oesophagus meet. Magnetic attraction among beads is sufficiently strong to prevent reflux but weak enough to allow food to pass.


Transoral Incisionless fundoplication (TIF): In this newer procedure, polypropylene fasteners tighten the lower oesophagus. TIF is performed using an endoscope inserted via the mouth and does not require a surgical incision.

Home Remedies

Here are few home remedies for acidity that actually work:

Prevention

Acidity can be prevented by the following methods:


  1. Do not consume spicy food 

  2. Eat more fruits and vegetables

  3. Eat small, regular meals

  4. Consume your last meal at least a few hours before sleeping

  5. Avoid medications such as non-steroidal anti-inflammatory drugs (NSAIDs) and steroids

  6. Reduce stress

  7. Carbonated beverages should be avoided

  8. Exercise should be immediately avoided after eating because it can cause the acid in the stomach to move up the oesophagus

  9. Food items such as mint, garlic, onion, tomatoes, coffee, and tea, should be avoided as such as possible as they can trigger acid reflux

References


  1. Wikidoc. Hyperchlorhydria [Internet] Available at: https://www.wikidoc.org/index.php/Hyperchlorhydria. (https://www.wikidoc.org/index.php/Hyperchlorhydria)

  2. Cleveland Clinic. GERD [Internet] [Updated on June 12, 2019] Available at: https://my.clevelandclinic.org/health/diseases/17019-gerd-or-acid-reflux-or-heartburn-overview.(https://my.clevelandclinic.org/health/diseases/17019-gerd-or-acid-reflux-or-heartburn-overview)

  3. Namayush. Amlapitta [Internet] Available at: http://namayush.gov.in/sites/all/themes/webcms/images/org_str/HYPERACIDITY_article_FAQ_final.pdf. (http://namayush.gov.in/sites/all/themes/webcms/images/org_str/HYPERACIDITY_article_FAQ_final.pdf)

  4. Namayush. Hyperacidity [Internet] [Updated on March 4, 2019] Available at: https://www.nhp.gov.in/hyperacidity-retrosternal-burning-hurqat-e-me%E2%80%99da_mtl.  (https://www.nhp.gov.in/hyperacidity-retrosternal-burning-hurqat-e-me%E2%80%99da_mtl)

  5. Medline Plus. Peptic Ulcer [Internet] Available at: https://medlineplus.gov/pepticulcer.html#cat_92. (https://medlineplus.gov/pepticulcer.html#cat_92)

  6. Cleveland Clinic. Esophageal Strictures [Internet] [Updated on November 27, 2020] Available at: https://my.clevelandclinic.org/health/diseases/21456-esophageal-strictures. (https://my.clevelandclinic.org/health/diseases/21456-esophageal-strictures)

  7. Fairview. Duodenitis [Internet] Available at: https://www.fairview.org/sitecore/content/Fairview/Home/Patient-Education/Articles/English/d/u/o/d/e/Duodenitis_40530. (https://www.fairview.org/sitecore/content/Fairview/Home/Patient-Education/Articles/English/d/u/o/d/e/Duodenitis_40530)

  8. John Hopkins Medicine. Patient Information on Esophageal pH Monitoring [Internet] Available at: https://www.hopkinsmedicine.org/gastroenterology_hepatology/_forms/patient_info/esophageal_ph_monitoring.pdf. (https://www.hopkinsmedicine.org/gastroenterology_hepatology/_forms/patient_info/esophageal_ph_monitoring.pdf)

  9. Gelhot AR, et al. Am. Fam. Physician. 1999;59(5):1161.

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