Hyperacidity: not hyped enough

Have you ever felt a burning sensation that runs up from your chest area and into your throat? It starts off feeling like an annoyance but in some cases, it becomes persistent, turning into a disease.

Jim Palmer, one of the greatest pitchers in the history of baseball, had chronicled about his battle with heartburn. “I had frequent and persistent heartburn for many years during my baseball career. I thought it was normal. I tried changing my eating habits in an effort to allow three hours between eating and going to bed. None of these efforts solved the problem. I have found that more and more people are identifying their own experiences with frequent and persistent heartburn as reflux disease,” he had chronicled. Today, at 74 years he is considered one of the famous spokespersons, in addition to Former US presidents Bill Clinton and George Bush, who’s been helping in increasing awareness about gastroesophageal reflux disease (GERD) — which in layman terms means ‘acidity’.

Hyperacidity is a common symptom that is synonymous with burning pain in the upper abdomen and or chest, usually secondary to bacterial infection, intake of certain drugs, lifestyle habits such as alcohol consumption and smoking. And it doesn’t only affect older people — even active, healthy teens can suffer from acidity, explain experts.

Dr G.V. Rao, Director, Chief of Surgical Gastroenterology, Transplantation Services and Minimally Invasive Surgery, Asian Institute of Gastroenterology, explains it further. “Eating large amounts of food and inadequate chewing of food causes upper abdominal fullness, bloating, nausea, and vomiting. When one has acidity, one experiences a burning sensation under the breastbone, accompanied by reflux of bitter contents. It usually worsens on bending forward or lying down,” says Dr Rao.

What causes acidity?

According to Dr Nitesh Pratap, Consultant Gastroenterologist, KIMS Hospitals, there are multiple causes of acidity, including consuming spicy food, eating a heavy meal and eating citric foods.

“In fact, chocolates can also cause acidity. And smoking and alcohol intake can worsen the symptoms. Stomach infections with H. pylori, pain medications such as ibuprofen and aspirin and high levels of stress/anxiety can also trigger acidity,” adds Dr Pratap.

Another commonly ignored aspect that induces acidity in most people is improper timing and spacing between meals during the day. According to Dr Rao, eating large quantities of food late in the night and immediately retiring to bed can also aggravate symptoms.

How can you treat the disease?

The treatment of acidity includes lifestyle modification as well as medication. “Lifestyle modification includes eating small frequent meals, avoiding spicy food and avoiding excess tea and coffee,” advises Dr Pratap.

The doctor also adds that antacids, proton pump inhibitors and antibiotics for H. pylori, as per medical advice are some of the medications used to treat acidity.

In some cases, people take antacids but still do not respond to it. In such cases, the treating doctor will evaluate for diseases causing acidity. “These tests include blood test and, if required, an upper gastrointestinal endoscopy in which a flexible scope is passed into the stomach to look for the cause of acidity. If a person with acidity has significant loss of weight, loss of appetite, vomiting or black-coloured stool, he should consult the specialist at the earliest,” the doctor adds.

How to manage GERD?

“Gastroesophageal reflux disease (GERD) is a lifestyle disorder that occurs when stomach acid frequently flows back into oesophagus. This acid reflux irritates the lining of oesophagus. GERD is a mild acid reflux that occurs at least twice a week; moderate to severe acid reflux occurs at least once a week,” explains Dr Ujawal Gajula, Senior Gastroenterologist, Apollo Hospitals.

Common symptoms of GERD:

• A burning sensation in your chest (heartburn), usually after eating, which might be worse at night
• Chest pain
• Difficulty in swallowing
• Regurgitation of food or sour liquid
• Sensation of a lump in your throat

Prevention:

• Have small, frequent meals
• Avoid trigger foods such as chocolates, citrus fruits and juices, peppermint, tomato products, fried, fatty, or spicy foods and garlic and onions
• Cut back on alcohol, tea, coffee and carbonated drinks
• Avoid eating before bedtime (try not to snack or dine at least 2 to 3 hours before you go to sleep)
• Prop up the head of your bed by 6 to 10 inches.
• Lose weight
• Stop smoking
• Chronic cough
• Laryngitis
• New or worsening asthma
• Disrupted sleep

Common causes of GERD

• “When you swallow, a circular band of muscle around the bottom of your oesophagus (lower oesophageal sphincter) relaxes to allow food and liquid to flow into your stomach. Then, the sphincter closes again. If the sphincter relaxes abnormally or weakens, the stomach acid can flow back up into the oesophagus. This constant backwash of acid irritates the lining of the oesophagus, often causing it to become inflamed," explains Dr Gajula.

Conditions that can increase GERD risk

• Obesity
• Hiatal hernia
• Pregnancy
• Connective tissue disorders, such as scleroderma
• Delayed stomach emptying (gastroparesis)

Factors that aggravate acid reflux

• Smoking
• Eating large meals or eating late at night
• Eating certain foods (triggers) such as fatty or fried foods
• Drinking certain beverages, such as alcohol or coffee
• Taking certain medications, such as aspirin and NSAIDS

Complications of GERD

Over time, chronic inflammation in your oesophagus can cause the following:

• Narrowing of the oesophagus (oesophageal stricture)
• An open sore in the oesophagus (oesophageal ulcer)

Tests for GERD

• Precancerous changes to the oesophagus (Barrett’s oesophagus). According to Dr Gajula, “Damage from acid can cause changes in the tissue lining the lower oesophagus. These changes are associated with an increased risk of oesophageal cancer. To confirm a diagnosis of GERD, or to check for complications, doctors might recommend upper endoscopy. For the ambulatory acid (pH) probe test, a monitor is placed in the oesophagus to identify when and for how long stomach acid regurgitates there. An oesophageal manometry is another test for GERD. It measures the rhythmic muscle contractions in the oesophagus when you swallow.”

Treatment for GERD

• One can usually control GERD with medication such as antacids that neutralise stomach acid, medications to reduce acid production (these medications-known as H-2-receptor blockers-include rantidine and famotidine
• Medications that block acid production and heal the oesophagus (these medications-known as proton pump inhibitors-are stronger acid blockers than H-2-receptor blockers and allow time for damaged oesophageal tissue to heal)
• Also, the doctor might recommend radiofrequency ablation and endoscopic or surgical fundoplication