The term acidity or heart burn is commonly used to describe a burning sensation in the chest or upper abdomen with or without nausea, bloating and regurgitation [vomiting]. This is mainly caused due to acid reflux in the stomach.
What is acid reflux?
There is a circular band of muscle [a sphincter] at the junction between the oesophagus [food pipe] and stomach. This relaxes to allow food down, but normally tightens up and stops food and acid leaking back up [refluxing] into the oesophagus. In effect, the sphincter acts like a valve.
Acid reflux is when some acid from the stomach leaks up [refluxes] into the oesophagus. This can cause oesophagitis in which there is inflammation of the inner lining of the oesophagus.
Gastro-oesophageal reflux disease [GORD] is a term used to describe this range of situations—acid reflux, with or without oesophagitis and symptoms.
What are the causes?
The sphincter at the bottom of the oesophagus normally prevents acid reflux. Problems occur if:
- The sphincter does not work well.
- The pressure in the stomach increases to a level higher than the sphincter can withstand. For example, during pregnancy, after a large meal, or when you bend forward.
What are the symptoms?
Heartburn is the main symptom. It is a burning feeling, which rises from the stomach or lower chest up towards the neck. Other common symptoms include feeling sick, acid taste in the mouth, bloating, belching, stomach pains, chest pains, and a burning pain while swallowing hot drinks. Like heartburn, these symptoms come and go, and tend to be worse after a meal.
However, some uncommon symptoms may occur. This makes the diagnosis difficult in some cases as the symptoms can mimic other conditions. For example:
- A persistent cough, particularly at night. This is due to the refluxed acid irritating the windpipe. Asthma symptoms can sometimes be due to acid reflux.
- Hoarseness.
- Severe chest pain develops in some cases [and may be mistaken for a heart attack].
How is it diagnosed?
Symptoms are the best indicators of acid reflux. If you have typical symptoms, there is no need to go for tests and treatment can be started. Tests are advised only if symptoms are severe, not typical, or if treatment does not improve symptoms. Tests may be also be advised if you are over age 50, when symptoms first appear.
- Endoscopy is the common test.
- A test to check the acidity inside the oesophagus may be done, if the diagnosis is not clear.
- Other tests such as heart tracings and chest X-ray may be done to rule out other possibilities, if the symptoms are not typical.
What are the treatments options?
Antacids
These are alkali liquids or tablets that neutralise the acid. A dose usually gives quick relief. There are many brands available, which come in different flavours and textures. You can use antacids as required for mild or infrequent bouts of heartburn.
Acid-suppressing medicines
Two groups of medicines are used—histamine receptor blockers [H2 antagonists] and proton pump inhibitors [PPIs]. They work in different ways, but both reduce [suppress] the amount of acid that you make in the stomach.
The treatment plan with acid-suppressing medicines can vary from person to person.
You may be advised to take a course for a month or so. This often settles symptoms and allows the oesophagus to heal.
Some people need regular acid-suppressing treatment. Without medication, their symptoms return quickly. Long-term treatment is thought to be safe, and side-effects are uncommon. The aim is to take the lowest dose that prevents symptoms.
It is unusual if reflux symptoms cannot be prevented by an acid-suppressing medicine. Hence, they also serve as an indicator of a different condition.
Prokinetic medicines
These are medicines that speed up the passage of food through the stomach. They help in some cases, particularly if you have bloating or belching in addition to pain or discomfort.
Surgery
This is an option in severe cases where medicines fail to prevent symptoms. An operation can tighten the lower oesophagus to prevent acid leaking up from the stomach. It can be done by keyhole surgery, and has a good success rate. In case the condition persists for a long time, there are chances of developing some problems that include:
Stricture. If you have severe and long-standing inflammation it can cause scarring and narrowing [a stricture] of the lower oesophagus. This is not a very common condition.
Cancer. You are at an increased risk of cancer of the oesophagus if you have recurrent and long-standing reflux. The risk is small, and it has to be stressed that most people with reflux do not develop cancer. Tell your doctor if you have pain or difficulty [food sticking] when you swallow.
Simple tips to prevent acidity
- Two tablespoonful of Isabgol [psyllium seed husks] in milk after every meal is beneficial for elimination of acidity.
- Orange juice mixed with roasted cumin seeds and some rock salt gives immediate relief from acidity.
- Mix equal amounts of ginger extract and mint extract. Taking this 2 – 4 times a day provides relief from acidity.
- Alternatively, ginger extract can be mixed with equal amount of honey. This should be taken in small amounts and must be placed on the tongue.
- Two teaspoonfuls amla powder [Indian gooseberry] taken once a day is also helpful.
- Coconut water is good for reducing acidity.
- Having black currants after meals or any time during the day provides instant relief from acidity.
— Team CW
This was first published in the January 2010 issue of Complete Wellbeing.
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