1. Definition of terms
Hyper-acidity – Basically means increased production of acid in the stomach or increased effects of acid presence on the stomach. This is the term most commonly used to describe symptoms and it will be used in the write-up to represent both superficial irritations and ulcers.
Heartburn – Feeling of burning sensation in the chest due to indigestion.
Esophagitis – Irritation and inflammation of the lining of the esophagus (food pipe).
Gastritis – Irritation and inflammation of the lining of the stomach.
Duodenitis – Irritation and inflammation of the lining of the duodenum which is the first part of the small intestine.
GERD (Gastro-Esophageal Reflux Disease) – A condition whereby acid produced in the stomach finds its way back to the esophagus due to ineffective control of the lower esophageal sphincter that ideally should ensure that stomach contents do not move back to the esophagus.
Ulcer – A wound that has formed on the inner lining of the esophagus, stomach or duodenum.
Gender – Symptoms of acidity affects both women and men.
Age – Can occur in children or adults though commoner in adults.
Role of genetics? – There are various studies to support the role of genetics especially in GERD and other conditions. Hyper-acidity symptoms tend to run in families and it is common to hear of generations suffering from symptoms, that is, a mother may have symptoms as well as her children.
3. Risk factors for the above
Foods – Different people develop symptoms due to different foods and each person must determine which foods cause or worsen their symptoms. Common culprits include citric fruits like lemons and oranges, vegetables like kales (sukuma wiki), fatty foods, chocolate and beans. In addition, some people get symptoms when they eat a lot of food regardless of type and especially when they try to lie down afterwards.
Drinks – Coffee, alcohol and caffeinated soft drinks may lead to symptoms in predisposed individuals.
Cigarette smoking – This is associated with symptoms due to its effect on the lining of the stomach and the normal protective mechanisms of the stomach and other organs.
Pregnancy – In early pregnancy, it is due to effects of progesterone which slows down peristalsis and movement of food. It is the same reason that constipation occurs in pregnancy. Subsequently, as the pregnancy progresses, the increase in abdominal girth due to the growing baby, displaces the intestines and stomach and this allows for acidic stomach contents to reflux to the esophagus.
Skipping meals – All people are encouraged to eat every 3 hours when they are awake. This is because acid production and digestion is a continuous process. Thus, people with tendency to skip meals continue to produce acid that has no food to work on and consequently works on the lining of the stomach and other organs.
Drugs – Drugs interfere with motility of the intestines as well as interfere with the pump that deals with acid production. Many drugs can cause hyper-acidity symptoms but common ones include some pain killers (NSAIDS) and antibiotics.
Infections – Food poisoning which we medically call gastro-enteritis means that the infective organism causes one to have stomach (gastro) symptoms like nausea, vomiting, anorexia and upper stomach pains on its own or in conjunction with small intestine (enteritis) symptoms of middle and lower abdominal pain and diarrhea.
Obesity – Increased abdominal girth as well as peri-organ fat leads to displacement of abdominal content especially on lying down predisposing to acidity as well as GERD.
Abdominal masses – once again due to increased abdominal size.
4. Signs and symptoms of hyper-acidity
- Pain – Pain is one of the cardinal symptoms of hyper-acidity at whatever stage of development. However, there are some characteristics of the pain that are crucial for suspicion.
Epigastric – This means that pain is in the upper mid section of the abdomen.
Hunger pain – This means that when one is hungry, they develop or worsen the pain.
Night pains – This is very characteristic as the pain tends to be worse at night and many people report being woken up by the pain.
Pain relief – The pain is relieved by eating something, drinking milk or taking an OTC antacid.
Episodic/periodic – Once pain is established and without treatment, the pain tends to last for a few days to weeks and then disappears. It then recurs when risk factor is exposed again.
- Belching – Belching is nature’s way of encouraging release of excess gas that accumulates and it makes the person feel better.
- Persistent/recurrent sore throat – People with recurrent episodes of sore throat with no obvious infections should be put on an antacid and see whether the symptoms disappear.
- Erosion of teeth – Reflux of acid into the mouth can lead to erosion of teeth.
- Nausea and anorexia – Presence of epigastric pain and discomfort makes one lose their appetite and people report being unable to eat. Others experience persistent nausea that worsens inability to eat which then worsens the epigastric pain
- Vomiting – When the stomach lining is sufficiently irritated, it protects itself by trying to remove the offending substance and this result in people vomiting. Once a person vomits the contents which are bitter, acidic and burns the throat, they usually feel much better.
- Waterbrash effect – This means that a person has sour saliva accumulating in their mouths and they have to keep spitting it out. Swallowing this saliva leaves one nauseated and some people end up throwing up.
5. Association with H. Pylori infection
Prevalence – According to Davidson’s Principles and Practice of medicine, the prevalence of H. Pylori in adults in the U.K is about 50%. It is thought to be as high as 90% in adults in developing countries. Around 90% of patients with duodenal ulcers and 70% of patients with stomach ulcers are infected with H. Pylori.
Diagnosis – H. Pylori is diagnosed using an antigen or antibody kit which uses specimen of blood or stool. There are instances when tests done on stool or blood samples are negative but the bacteria is discovered on staining of specimen collected during endoscopy.
Eradication – Eradication of H.P ylori is done using “triple therapy.” This is accomplished using two antibiotics (amoxicillin and clarithromycin/metronidazole) and an antacid (omeprazole or other PPI) for 7 to 14 days. The antacid is usually continued after that until adequate healing is achieved.
Bleeding – Erosion of the lining of the esophagus, stomach or duodenum can continue until it erodes a blood vessel. This leads to massive bleeding and many patients present with vomiting blood (hematemesis). Others present with black stool which contains altered blood that’s been digested. Massive, repeated bleeding can be fatal.
Obstruction – Recurrent erosion with healing leads to healing with formation of fibrous tissue which leads to narrowing of the lumen of the organs. This can result in total occlusion of the lumen with features of obstruction.
Cancer – Recurrent inflammation of the inner lining of the duodenum, stomach and esophagus can lead to abnormal changes of the cells of these organs leading to development of cancer.
Barium exam – This is a type of X-ray that is taken after one has been given a substance to consume. X-ray is taken as the patient is swallowing and/or after the substance has settled in the stomach.
Endoscopy – This involves insertion of a tube with a camera down one’s throat into the esophagus, stomach and duodenum. This enables the doctor to visualize the inner linings of the organs, take photographs as well as take biopsy samples for histology (which is how cancer is diagnosed) as well as staining to check for H. Pylori.
8. Drug treatment
Acute – A patient presenting with the first case of the above especially if it is associated with an obvious cause should be treated for 1-6 weeks as determined by the practitioner so as to allow for total healing of the lining of the organs.
Chronic – Patients with recurrent or persistent symptoms should be adequately investigated for any underlying issues. They usually require much longer treatment and may even be years. Some schools of thought advocate for treatment for life for those who cannot or will not change lifestyles that predispose to symptoms like taking alcohol or prescription medications.
9. Drugs used in treatment
Children – Children are usually managed with liquid antacids but stronger medications can be prescribed by health practitioners depending on severity of conditions.
Pregnant/lactating mothers – These individuals are usually managed with liquid antacids or H2 receptor antagonists like ranitidine.
Adults – A wide range of treatment options are available and include liquid antacids, H2 receptor antagonists and PPIs like omeprazole/esomeprazole/rabeprazole.
10. Lifestyle modification to manage hyper-acidity symptoms
- Elevation of one’s head by (15cm) when lying down by either physically elevating the bed or using pillows
- Moderate ingestion of foods that cause symptoms
- Special care with “risk” medications
- Do not lie down for at least two hours after meals
- Avoid large meals
- Reduce or stop intake of alcohol, coffee and other caffeinated drinks especially if they cause symptoms.
- Do not skip meals
- Stop smoking
- Loose weight if overweight