Acidity (Acid Reflux)

Acidity is described in terms of the pH value of a substance. The pH value ranges from 0 to 14 and is an indication of the acidity or basicity of an aqueous solution. A value of zero indicates highly acidic, a value of 7 indicates neutrality and a pH of 14 signifies highly basic or alkaline. Water has a pH value of 7. 

Acidity in the stomach is the result of excess gastric acid production that may cause heartburn and other problems. The purpose of the acid secreted in moderate quantities in the stomach is to aid in the digestion of proteins that are consumed. The pH of the stomach acid ranges between 1.5 to 3.5.

Food consumed via the mouth passes through the pharynx (back of the throat), esophagus or the food pipe and reaches the stomach. Food is mixed with saliva in the mouth and reaches the stomach in about seven seconds. At the end of the esophagus is the flap called lower esophageal sphincter (LES) that opens to let the food into the stomach. 

The sphincter is a one-way flap that allows the food to go from esophagus to stomach and not backwards. Occasionally, the acid or the food contents are pushed back into the esophagus from the stomach, and the esophagus lining gets disturbed. The lining of the esophagus is not as well protected as that of the stomach. This acidity of the esophagus causes heartburn. The condition is experienced as a painful burning sensation in the middle of the chest.

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Acid reflux is when some of the acid content of the stomach flows up into the esophagus, into the gullet, which moves food down from the mouth. Despite the name, heartburn has nothing to do with the heart.

The stomach contains hydrochloric acid, a strong acid that helps break down food and protect against pathogens such as bacteria.

The lining of the stomach is specially adapted to protect it from the powerful acid, but the esophagus is not protected.

A ring of muscle, the gastroesophageal sphincter, normally acts as a valve that lets food into the stomach but not back up into the esophagus. When this valve fails, and stomach contents are regurgitated into the esophagus, the symptoms of acid reflux are felt, such as heartburn.

GERD affects people of all ages, sometimes for unknown reasons. Often, it is due to a lifestyle factor, but it can also be due to causes that cannot always be prevented.

One cause that is not preventable is a hiatal (or hiatus) hernia. A hole in the diaphragm allows the upper part of the stomach to enter the chest cavity, sometimes leading to GERD.

Other risk factors are more easily controlled:

  • obesity
  • smoking (active or passive)
  • low levels of physical exercise
  • medications, including drugs for asthma, calcium-channel blockers, antihistamines, painkillers, sedatives, and antidepressants

Pregnancy can also cause acid reflux due to extra pressure being placed on the internal organs.

Acid reflux usually produces heartburn, whether it is due to a single episode of overeating or persistent GERD.

Heartburn is an uncomfortable burning sensation that occurs in the esophagus and is felt behind the breastbone area. It tends to get worse when lying down or bending over. It can last for several hours and often worsens after eating food.

The pain of heartburn may move up toward the neck and throat. Stomach fluid can reach the back of the throat in some cases, producing a bitter or sour taste.

If heartburn occurs two or more times a week, it is known as GERD for short.

Other symptoms of GERD include:

  • dry, persistent cough
  • wheezing
  • asthma and recurrent pneumonia
  • nausea
  • vomiting
  • throat problems, such as soreness, hoarseness, or laryngitis (voice box inflammation)
  • difficulty or pain when swallowing
  • chest or upper abdominal pain
  • dental erosion
  • bad breath

Acid reflux and heartburn are common and relatively easy to diagnose, however, they can be confused with other chest complaints such as:

  • heart attack
  • pneumonia
  • chest wall pain
  • pulmonary embolus

GERD is often diagnosed simply by finding no improvement in heartburn symptoms in response to lifestyle changes and acid reflux medication.

Gastroenterologists may also arrange the following investigations:

  • endoscopy: camera imaging
  • biopsy: taking a tissue sample for laboratory analysis
  • barium X-ray: imaging the esophagus, stomach, and upper duodenum after swallowing a chalky liquid that helps provide contrast on images
  • esophageal manometry: pressure measurement of the esophagus
  • impedance monitoring: measuring rate of fluid movement along the esophagus
  • pH monitoring: acidity testing

The main treatment options for acid reflux are:

  • PPIs, including omeprazole, rabeprazole, and esomeprazole
  • H2 blockers, including cimetidine, ranitidine, and famotidine
  • Over-the-counter treatments, such as antacids, which are available to buy online.
  • Alginate drugs, including Gaviscon

The main treatment options for people who repeatedly experience acid reflux in GERD are either PPIs or H2 blockers, both of which are medications.

PPIs and H2 blockers decrease acid production and reduce the potential for damage caused by acid reflux.

These medications are generally safe and effective, but like any prescription drug, they are not appropriate for all people with reflux disease and can cause side effects.

For instance, they can cause problems absorbing nutrients. This can lead to malnutrition.

OTC remedies for acid reflux

For people who experience heartburn or indigestion infrequently, perhaps in association with occasional food and drink triggers, OTC treatments to reduce the acidity of the stomach contents are available.

These liquid and tablet formulations are called antacids, and there are dozens of brands available, all with similar effectiveness. They may not work for everyone, and any need for regular use should be discussed with a doctor.

Antacids provide rapid but short-term relief by reducing the acidity of the stomach contents.

They contain chemical compounds such as calcium carbonate, sodium bicarbonate, aluminum, and magnesium hydroxide. They can also inhibit nutrient absorption, leading to deficiencies over time.

Alginate drugs such as Gaviscon

Gaviscon is probably the best-known heartburn therapy. It has a different mode of action than antacid drugs. Alginate drugs such as Gaviscon vary slightly in composition, but they usually contain an antacid.

The alginic acid works by creating a mechanical barrier against the stomach acid, forming a foamy gel that sits at the top of the gastric pool itself.

Any reflux is then relatively harmless as it consists of alginic acid and not damaging stomach acid.

The active ingredient—alginate—is found naturally in brown algae.

If you want to buy Gaviscon, then there is an excellent selection available online.

Other options

Other possible treatment methods include:

  • Sucralfate acid suppressants
  • Potassium-competitive acid blockers
  • Transient lower esophageal sphincter relaxation (TLESR) reducers
  • GABA(B) receptor agonist
  • mGluR5 antagonist
  • Prokinetic agents
  • Pain modulators
  • Tricyclic antidepressants
  • Selective serotonin reuptake inhibitors (SSRIs)
  • Theophylline, a serotonin-norepinephrine reuptake inhibitor

If GERD is severe and unresponsive to medical treatment, a surgical intervention known as fundoplication may be needed.

Acidity can be prevented by changing certain food items, patterns and eating habits. Some of the ways to prevent acidity are as follows:

  • Eating more fruits and vegetables that are not very acidic.
  • Eating small-sized meals at regular intervals.
  • Eating dinner at least 1 – 2 hours before going to sleep.
  • Maintaining a healthy weight.
  • Exercising.
  • Drinking at least 3 liters of water a day.
  • Not drinking water for up to 30 minutes before a meal and one hour after a meal.
  • Not wearing tight belts or clothes that compress the abdomen area.

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