Acidity

Overview Of Acidity 

• Despite its name, heartburn has nothing to do with the heart.
• But some of the symptoms are similar to those of a heart attack or heart disease.
• Heartburn Is an intermittent symptom, most commonly these symptoms often occur after meals, on lying down or with bending, straining or heavy lifting.
• They are classical of gastro-oesophageal reflux but up to 50%.
• The discomfort is relieved with drinking water or antacid but can occur frequently interfering with normal activities including sleep.
• The association between heartburn and gastroesophageal reflux disease (GERD) is so strong that empirical therapy for GERD has become accepted management.
• However, the term “heartburn” is often misused and/or referred to with other terms such as “indigestion” or “repeating,” making it important to clarify the intended meaning.[4]

What is acidity?

• The food we eat goes into our stomach through the esophagus. The gastric glands in your stomach create acid, which is necessary to digest the food.
• When the gastric glands create more acid than needed for the digestion process, you can feel a burning sensation below the breastbone.
• Therefore, This condition is commonly known as acidity.
• Acidity, also called acid reflux, is a condition that is characterized by heartburn that is felt around the lower chest area.
• It is a common condition that occurs when stomach acid flows back up into the food pipe.
• Additionally, The most common acid reflux symptom is a burning sensation in the chest or pain.
• While most people suffer in pain, they do not realize that poor lifestyle choices are the primary reason behind acidity.[4]
• When acidity symptoms occur more than twice a week, your doctor may diagnose you with Gastroesophageal reflux disease or GERD.
• Chronic acidity may lead to serious risks that include:

Esophagus damage:

It is the tube that connects your mouth to your stomach and when acid moves back up and enters the esophagus, it sets the stage for esophageal ulcers, oesophagitis, esophageal strictures, and Barrett’s Oesophagus.

Esophagus cancer:

There is an increased risk of esophagus cancer, which is more likely if you have a history of the condition in the family.

Cavities/tooth decay:

Acid reflux can wear down the enamel of your teeth and lead to cavities.[4]

Epidemiology:

Causes

Acidity arises when the gastric glands in the stomach produce an excessive amount of acid.

Factors that cause acidity include:

1. Unhealthy eating habits

• Skipping meals or eating at irregular times
• Eating just before sleeping
• Overeating
• Consumption of spicy food
• High intake of table salt
• Diet low in dietary fiber

2. Excessive consumption of certain food

• Drinks such as tea, coffee, carbonated drinks, soft drinks
• Extremely spicy food
• Fat rich food such as pizza, doughnuts, and fried food

3. Side-effects of certain temporary medications as well as existing medications.

It includes medications such as

• Non-steroidal anti-inflammatory drugs
• Medicines for high blood pressure
• Antibiotics
• Depression and anxiety medications

4. Stomach disorders

Stomach disorders encompass a range of conditions, including gastroesophageal reflux disease (GERD), tumors, and peptic ulcers, among others.

5. Other causes of Acidity include:

• Consumption of non-vegetarian food
• Excessive stress
• Lack of sleep
• Frequent smoking
• Lack of physical exercise
• Frequent consumption of alcohol

People who suffer from medical conditions such as asthma, diabetes, and connective tissue disorder are more prone to acidity. In conclusion, It is also a common problem in people who are higher-weight person, pregnant women, or women who are nearing menopause.[4]

Types Of Acidity 

In the context of medical conditions related to excessive stomach acid, several types of acidity can be identified:

Gastroesophageal Reflux Disease (GERD):

• This chronic condition is characterized by the frequent backflow of stomach acid into the esophagus, leading to heartburn, regurgitation, and chest pain.[6]

Peptic Ulcer Disease (PUD):

• This condition involves the development of ulcers (sores) on the lining of the stomach or duodenum (the first part of the small intestine). These ulcers can be caused by the bacteria Helicobacter pylori or the use of certain medications like NSAIDs. [7]

Functional Dyspepsia (FD):

• This disorder is characterized by chronic or recurrent pain or discomfort in the upper abdomen without any obvious structural or biochemical cause. Stress and anxiety are often associated with FD. [8]

Zollinger-Ellison Syndrome (ZES):

• This rare condition involves tumors in the pancreas or duodenum that produce excessive gastrin, a hormone that stimulates the stomach to produce acid. This leads to severe peptic ulcers. [9]

These types of acidity differ in their underlying causes, symptoms, and treatment approaches. Proper diagnosis by a healthcare professional is essential to determine the specific type of acidity and recommend the most appropriate treatment plan.

Risk Factors 

Factors that can aggravate acid reflux include:

Pathogenesis Of Acidity 

The development of acidity, also known as gastroesophageal reflux disease (GERD), is a complex process involving multiple factors and mechanisms:

Lower Esophageal Sphincter (LES) Dysfunction:

• The LES is a muscular ring at the junction of the esophagus and stomach that normally prevents stomach contents from flowing back into the esophagus. In GERD, the LES weakens or relaxes inappropriately, allowing acidic stomach contents to reflux into the esophagus.

Hiatal Hernia:

• A hiatal hernia develops when a portion of the stomach protrudes upward through an opening in the diaphragm and into the chest cavit This can disrupt the normal function of the LES and contribute to GERD.

Impaired Esophageal Clearance:

• Normally, the esophagus clears refluxed acid quickly through peristalsis (muscular contractions) and saliva production.However, if these protective mechanisms are impaired, acid can linger in the esophagus, leading to irritation and damage.

Delayed Gastric Emptying:

• Furthermore, if the stomach empties slowly, the volume and pressure of stomach contents increase. Consequently, this can promote reflux by forcing stomach acid back up into the esophagus.

Increased Gastric Acid Production:

• In some cases, excessive gastric acid production can contribute to GERD symptoms. [7]

Duodenogastroesophageal Reflux:

• Moreover, in addition to stomach acid, the reflux of bile and other duodenal contents can also irritate and damage the esophageal mucosa, further contributing to GERD symptoms.

Genetic Predisposition:

• Certain genetic factors may increase susceptibility to GERD.[6]

Pathophysiology:

When we eat, food travels from our mouth to our stomach via the esophagus. In the stomach, gastric glands produce acid, a crucial component for digesting food. However, if these glands generate an excess of acid, it can lead to a burning sensation below the breastbone, commonly known as acidity or heartburn. This burning sensation often stems from a malfunctioning lower esophageal sphincter (LES), a muscular valve that normally prevents stomach acid from flowing back up into the esophagus

Location of LES:

It’s located where the esophagus meets the stomach – below the rib cage and slightly left of center.

Typically, the lower esophageal sphincter (LES), aided by gravity, acts as a gatekeeper, ensuring that stomach acid remains in the stomach. When functioning correctly, the LES opens to allow food to enter the stomach or to permit belching and then promptly closes. However, if the LES opens too frequently or doesn’t close tightly enough, stomach acid can escape into the esophagus, leading to a burning sensation known as heartburn. This malfunctioning LES is often attributed to two primary factors

• overeating:

One is overeating, which puts too much food in your stomach.

• pressure on stomach

Another is too much pressure on your stomach, often due to obesity, pregnancy, or constipation.[3]

Clinical Features:

• Heartburn: The most common symptom, described as a burning sensation in the chest or upper abdomen, often radiating to the neck or throat. It is usually worse after meals, when lying down, or bending over.
• Regurgitation: The backflow of acidic stomach contents into the mouth, leaving a sour or bitter taste.
• Dysphagia: Difficulty swallowing, which may be due to esophageal inflammation or stricture (narrowing).
• Chest Pain: GERD can cause chest pain that may mimic angina (heart pain).
• Chronic Cough: GERD can trigger a persistent cough, especially at night.
• Hoarseness: Acid reflux can irritate the larynx (voice box), leading to hoarseness.
• Asthma Exacerbation: GERD can worsen asthma symptoms in some individuals.
• Nausea: A feeling of sickness or discomfort in the stomach.
• Belching: The release of gas from the stomach through the mouth.

• Bloating: A feeling of fullness or tightness in the abdomen.

• Water Brash: The sudden filling of the mouth with saliva, often triggered by reflux.

• Globus Sensation: A feeling of a lump in the throat.

The severity and frequency of symptoms can vary widely among individuals. Some people may experience only mild heartburn occasionally, while others may have frequent and severe symptoms that significantly impact their quality of life.

It’s important to note that these are just the common clinical features. GERD can sometimes present with atypical symptoms or mimic other conditions, making diagnosis challenging. [6] [7]

Sign & Symptoms:

• Acidity symptoms differ from one person to another.
• Most things that contribute to gas also lead to acidity meaning gas and acidity symptoms are almost similar.
• While the most common acid reflux symptoms are chest pain and burning sensation below the breastbone, there are other symptoms that are uncommon.
• Acidity symptoms include the following:
  • Burning sensation also pain in the stomach
  • Burning sensation also pain in the throat
  • Difficulty either swallowing or the sensation of food being stuck in your throat
  • Frequent burping or hiccups, for no apparent reason
  • Furthermore, Burning sensation and pain in the chest
  • Regurgitation: Prolonged sour taste in the mouth or bitter-tasting acid that backs up into your throat and mouth
  • Post-meal heaviness
  • Nausea
  • Constipation
  • Indigestion
  • Bad breath
  • Restlessness [4]

Clinical Examination:

An esophageal pH test measures how often stomach acid enters the esophagus, the tube that connects your throat to your stomach. It also measures how long the acid stays there. The test involves placing a catheter (a thin tube), or a special device called a pH probe, into your esophagus. The catheter or device will measure your acid level (known as pH level) for 24 to 96 hours.

The test can show if you have acid reflux or GERD (gastroesophageal reflux disease). Acid reflux is a disorder that happens when stomach acid flows back into the esophagus. When the acid touches the esophagus, it can cause a burning feeling in your chest or neck. This is known as heartburn.

Acid reflux can lead to GERD, a more serious form of reflux. While acid reflux and GERD are not life-threatening, the symptoms can be very uncomfortable and affect your quality of life. Also, if not treated, GERD can damage the esophagus and lead to more serious health problems.

Other names: esophageal pH monitoring 24-hour esophageal pH test, esophageal reflux monitoring, esophageal acidity test, pH monitoring, pH probe study [5].

Diagnosis:

Diagnostic tests can help in understanding the extent of acidity and help in deciding the course of the treatment.

Some diagnostic tests for acidity include:

• Barium: A solution containing barium is swallowed also the movement is tracked using an X-ray.
• pH Monitoring: A device is inserted into the patient’s esophagus and left there for 1 or 2 days. The device measures the amount of acid in the esophagus.
• Esophageal Manometry: A device to check the function of the esophagus also the lower esophageal sphincter.
• Endoscopy: A long flexible tube that has a light also a camera is inserted down the throat. The camera shows the esophagus and the stomach, their contents also the mucus lining.
• Biopsy: A small sample of the stomach tissue may be taken for analysis and biopsy. The sample is usually taken during endoscopy.

Differential Diagnosis:

• GERD
• Gastritis
• Peptic Ulcer
• Chron’s Disease
• Gastric Adenocarcinoma
• Gastrinoma

Complications:

The term "acidity" is often used colloquially to refer to a range of digestive issues, most commonly gastroesophageal reflux disease (GERD). GERD is a chronic condition where stomach acid frequently flows back into the esophagus, causing irritation and inflammation.

Complications of GERD (as per medical texts):

• Esophagitis: Inflammation of the esophagus lining.[7]
• Esophageal Stricture: Narrowing of the esophagus due to scarring from acid reflux.[6]
• Barrett’s Esophagus: A precancerous condition where the lining of the esophagus changes. [13]
• Esophageal Ulcers: Open sores in the lining of the esophagus.[14]
• Respiratory Problems: Acid reflux can trigger or worsen asthma, chronic cough, and other respiratory issues.[15]

Investigation:

• X-ray of the esophagus
• Upper gastrointestinal endoscopy
• Ambulatory acid probe test (esophageal pH monitoring):An acid monitor is put into your esophagus and connected to a small computer that you can wear on a belt or shoulder  It measures when stomach acid backs up into your esophagus and for how long.
• Esophageal motility testing (esophageal manometry):A catheter is put into your esophagus and measures pressure and movement.[3]

Heartburn Complications:

Occasional heartburn isn’t dangerous. But GERD can sometimes lead to serious problems, such as:

• A long-term cough
• Laryngitis
• Inflammation or ulcers of the esophagus
• Problems swallowing because of a narrow esophagus
• Barrett’s esophagus, a condition that can make it more likely to get esophageal cancer

Treatment:

• To address acidity, your doctor may recommend a multi-faceted approach depending on the severity of your condition.

  • Firstly, they might suggest antacids containing aluminum, calcium, or magnesium to neutralize stomach acid and provide immediate relief.
  • Secondly, they may also recommend histamine-blocking agents (H2 receptor blockers), such as cimetidine, nizatidine, ranitidine, or famotidine, to reduce the production of stomach acid.
  • If the condition is more severe, they may prescribe proton pump inhibitors (PPIs), which are more potent acid reducers.
  • In extremely severe cases where other treatments have failed, your doctor may consider Vagotomy surgery, a procedure that helps reduce the production of acid in the stomach by cutting the vagus nerve, which stimulates acid secretion.

Prevention:

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

• Making certain lifestyle adjustments can significantly help manage and reduce the occurrence of acidity. These include:  

   
  • Dietary Modifications: Prioritize consuming fruits and vegetables that are less acidic. Additionally, focus on eating smaller, more frequent meals throughout the day, and ensure you finish your dinner at least 1-2 hours before bedtime.
  • Weight Management: Maintain a healthy weight through a balanced diet and regular exercise, as excess weight can exacerbate acid reflux.  
    
     
  • Hydration: Drink at least 3 liters of water daily, but avoid drinking water 30 minutes before and one hour after meals to prevent diluting stomach acid.
  • Physical Activity: Engage in regular exercise to promote digestion and overall health.  
    
     
  • Clothing Choices: Avoid wearing tight belts or clothing that constricts the abdomen, as this can put pressure on the stomach and worsen acid reflux

Homeopathic Treatment of Acidity:

 Homeopathy treats the person as a whole. It means that homeopathic treatment focuses on the patient as a person, as well as his pathological condition. The homeopathic medicines selected after a full individualizing examination and case-analysis.

Which includes

•  The medical history of the patient,
• Physical and mental constitution,
• Family history,
• Presenting symptoms,
• Underlying pathology,
• Possible causative factors etc.

A miasmatic tendency (predisposition/susceptibility) also often taken into account for the treatment of chronic conditions.

What Homoeopathic doctors do?

 A homeopathy doctor tries to treat more than just the presenting symptoms. The focus is usually on what caused the disease condition? Why ‘this patient’ is sick ‘this way’?

The disease diagnosis is important but in homeopathy, the cause of disease not just probed to the level of bacteria and viruses. Other factors like mental, emotional and physical stress that could predispose a person to illness also looked for. Now a days, even modern medicine also considers a large number of diseases as psychosomatic. The correct homeopathy remedy tries to correct this disease predisposition.

Homeopathic Treatment:

As a highly individualized system of medicine, homeopathy strives to identify a specific remedy tailored to each unique case. By stimulating the body’s natural defenses, homeopathy aims to boost the immune system, which plays a crucial role in eliminating disease-causing organisms, resolving illness, and preventing future health issues. Homeopathic prescriptions are carefully determined based on the nature of the illness and the patient’s individual constitution. This personalized approach can provide lasting relief from recurrent heartburn or acidity. However, it’s crucial to remember that self-treatment is strongly discouraged. Consulting a qualified homeopathic physician is essential to ensure the safe and effective use of homeopathic remedies.

Homeopathic medicine:

AMMONIUM CARBONICUM:

his individual experiences pain in the pit of their stomach, accompanied by heartburn, nausea, waterbrash, and chilliness, indicative of flatulent dyspepsia. These symptoms worsen in the evenings and between 3 to 4 a.m. Notably, the individual finds relief by lying on the painful side or on their stomach

ANTIMONIUM CRUDUM:

Desire for acids, pickles with thirst evening also at night. In addition, Eructation tasting of the ingesta heartburn, nausea, vomiting. Bread, pastry acids. Sour water, cause gastric and intestinal complaints, constant belching, sweetish waterbrash and bloating after eating. Most importantly, Worse – in evening, acids also wine. Better – open air and rest.

ARSENICUM ALBUM:

Anxiety in pit of stomach, burning pain, craves acids and coffee. Heartburn, gulping up of acid also bitter substances which excoriate throat. Long lasting eructation. Great thirst. Dyspepsia from vinegar, acids, ice cream, ice-water, tobacco. Nausea retching and vomiting. Specifically, Worse from cold drinks or food. Better – warm drinks.[2]

CARBO VEGETABILIS:

Eructation, heaviness, fullness and sleepiness. Flatulence with pain. Moreover, Eructation after eating and drinking. Temporary relief from belching. Rancid sour or putrid eructation. Moving Ahead, Waterbrash, asthmatic breathing from flatulence. Sensitiveness of epigastric region. Distension of abdomen. Also, Nausea in morning. Crampy pains. Distress comes 1/2 hour after eating. Particularly, Worse from fat foot, coffee, wine evening. Better – from eructation, cold

CALCAREA CARBONICA:

Craving for indigestible things. Frequency sour eructations, sour vomiting. Dislike of fat. Heartburn and loud belching. Cramps in stomach with swelling. Epigastric region, painful to touch. Repugnance to hot foot. Loss of appetite when overworked. Worse – exertion, mental or physical.

LYCOPODIUM:

This individual experiences dyspepsia, specifically triggered by farinaceous and fermentable foods like corn, nuts, meat, flour, and cabbage. They report sour eructations and a sensation of incomplete, burning eructations that rise only to the pharynx, causing a burning sensation that persists for hours. Additionally, they experience rolling flatulence and a sense of fullness even after eating a small amount of food. These symptoms are most pronounced between 4-8 p.m., particularly on the right side. However, they find relief with warm drinks and food

NATRUM MURIATICUM:

Heartburn with palpitation. Unquenchable thirst. Sweats while eating. Throbbing in pit of stomach. Sticking sensation in cardiac orifice.

NUX VOMICA:

This individual experiences a sour taste and nausea after eating, accompanied by a sensation of weight and pain in the stomach. They also report flatulence and pyrosis (heartburn), along with sour, bitter eructations. A key characteristic is their ravenous hunger, especially preceding an episode of dyspepsia. Their stomach region is highly sensitive to the touch and feels bloated with pressure for several hours after eating. They have a desire for stimulants, yet paradoxically, experience dyspepsia after consuming strong coffee. Furthermore, they struggle with belching gas and experience an unproductive urge to vomit. Their symptoms are aggravated by stimulants, alcohol, and rich foods.

PULSATILLA:

This individual experiences bitter eructations, stomach pain, flatulence, and an aversion to fatty and warm foods and drinks. They have heartburn, acidity, and post-meal tightness. Despite thirstlessness, they experience stomach pain and vomiting after eating. A heavy sensation in the stomach, waterbrash, and distorted taste are common upon waking. Symptoms worsen with heat, rich food, and after eating, but improve with cold food and drinks

PETROLEUM:

Heartburn, hot sharp sour eructation distension. Feeling of great emptiness. Strong aversion to fat food, meat. Worse cabbage. Hunger immediately after stool. Nausea also accumulation of water in mouth. Gastralgia, relieved by constant eating. Particularly, Worse – eating, mental state.

BRYONIA:

This individual experiences nausea and faintness upon rising, accompanied by vomiting of bile and water immediately after eating. Warm drinks exacerbate their symptoms and are often vomited back up. Their stomach is sensitive to touch, and they are particularly prone to dyspeptic ailments during hot summer weather. The epigastric region is also sensitive to touch. Their symptoms are generally worse in the morning, after eating, and in hot weather, but improve with cold things

CONIUM:

This individual experiences intense nausea, acid heartburn, and acid eructations, which worsen significantly upon going to bed. While they find temporary relief from eating, their symptoms intensify a few hours after meals. They describe a persistent sensation of acidity and burning, along with a distinct, painful spot at the level of the sternum

CAPSICUM:

This individual presents with a burning sensation at the tip of their tongue and experiences atonic dyspepsia, characterized by weak muscle tone in the digestive tract. They suffer from excessive flatulence, particularly noticeable in debilitated individuals. A strong craving for stimulants is also present. They experience vomiting and a sinking sensation in the pit of their stomach. Despite experiencing significant thirst, drinking causes shuddering. Most notably, they describe a burning sensation that extends from their mouth all the way to their rectum.

Diet & Regimen

Acidity is a widespread problem that most people experience at some point in their lives. Often, individuals prefer to try home remedies before resorting to medication. Here are some common home remedies for acid reflux:

Coconut water:

• In addition to its refreshing taste, this beverage is known to soothe the stomach and support digestive health. To maximize its benefits, aim to drink at least two glasses each day

Watermelon juice:

• Watermelon juice is an excellent way to combat acidity. Consider enjoying a glass with breakfast for a refreshing and soothing start to your day.

Fresh lime juice:

• that is taken at least an hour before lunch helps to reduce the uneasiness caused by acidity.

Buttermilk:

• A glass of buttermilk after a spicy meal helps reduce the uneasiness as buttermilk contains lactic acid that normalises acidity in the stomach

You can either munch on a few basil leaves, or boil them in water and drink it frequently to reduce acid reflux. You can also do this with mint leaves. Drink a glass of lukewarm water after every meal Include banana, cucumber also yoghurt in your diet. They are known to give instant relief from acidity. Surprisingly, sucking on a piece of clove when you have acidity helps to reduce the symptoms.

Ginger:

• Ginger aids in digestion. For instance, Use ginger in your cooking or boil it in a glass of water, reduce to half glass and consume the water.

Cumin:

• Cumin is a great remedy for acidity. Moreover, Munch on some cumin or boil a teaspoon of cumin in a glass of water. Boil until the water is reduced to half. Drink it on an empty stomach.

Try chewing gum! As unbelievable as it may sound, chewing gum generates saliva that helps to move the food through the esophagus. Take a tablespoon of apple cider vinegar with a glass of water every morning on an empty stomach. Drink at least two liters of water every day

Lifestyle changes that may help include:

Losing weight if you are higher-weight person

Consumption of healthy food

Moving Further, Maintaining regular eating time with dinner ending at least two to three hours before bed

Having small regular meals

Following a low-carb diet

Avoid food that triggers Acidity such as raw onion and citrus juice

Avoiding caffeine and carbonated drinks

Also, Avoid sleeping on your right side

Cut down on smoking also alcohol

Keeping your mind and body active

Then, Starting stress-relieving activities

Try to avoid medications that cause Acidity

When the symptoms are mild, home remedies aid in relieving the discomfort caused by the excessive acid produced. You can also take control of acid reflux with few lifestyle changes. In conclusion, if the symptoms are severe, you may need immediate medical attention.[3

Do’s:

• Eat smaller, more frequent meals: This helps reduce pressure on the stomach and prevents overproduction of acid.
• Maintain a healthy weight: Excess weight can increase pressure on the abdomen and worsen reflux symptoms.
• Elevate the head of your bed: This helps gravity keep stomach acid from flowing back into the esophagus.
• Choose foods low in acidity: This includes lean proteins, vegetables, whole grains, and healthy fats.
• Identify and avoid trigger foods: Common triggers include spicy foods, citrus fruits, tomatoes, chocolate, caffeine, and alcohol. [16]

Don’ts:

• Don’t eat large meals, especially before bed: This can increase pressure on the stomach and trigger reflux symptoms.
• Don’t lie down or bend over after eating: This can make it easier for stomach acid to flow back into the esophagus.
• Don’t smoke: Smoking weakens the lower esophageal sphincter, making reflux more likely.
• Don’t wear tight-fitting clothing: This can increase pressure on the abdomen and worsen reflux symptoms.
• Don’t self-medicate with over-the-counter antacids: While these may provide temporary relief, overuse can mask underlying issues and lead to complications. [17]

(Please note: This information is not intended as a substitute for professional medical advice. Always consult with your doctor for diagnosis and treatment.)

Reference:

1. Text Book of Medicine Golwala 25^th edition
2. Homoeopathic Body-System Prescribing – A Practical Workbook of Sector Remedies
3. https://www.webmd.com/heartburn-gerd/guide/understanding-heartburn-basics
4. https://www.healthifyme.com/blog/acidity-symptoms-causes-treatment-home-remedies/
5. [5]https://medlineplus.gov/lab-tests/esophageal-ph-test/
6. [6]Sleisenger and Fordtran’s Gastrointestinal and Liver Disease Review and Assessment (9th Edition) by Anthony Fauci, et al. (2010). 
7. Harrison’s Principles of Internal Medicine (20th Edition) by Dennis L. Kasper, et al. (2018).
8. Rome IV Functional Gastrointestinal Disorders: Disorders of Gut-Brain Interaction by Douglas A. Drossman, et al. (2016). Gastroenterology.
9. Sleisenger and Fordtran’s Gastrointestinal and Liver Disease (11th Edition) by Mark Feldman, et al. (2021). Saunders.
10. Epidemiology and symptom profile of gastroesophageal reflux in the Indian population: Report of the Indian Society of Gastroenterology Task Force (2011)
11. Indian consensus on gastroesophageal reflux disease in adults: A position statement of the Indian Society of Gastroenterology (2019)
12. Shedding light on the epidemiology of gastroesophageal reflux disease in India – a big step forward (2011)
13. Yamada’s Textbook of Gastroenterology, 7th Edition, 2024
14. Goldman-Cecil Medicine, 26th Edition, 2023
15. Murray and Nadel’s Textbook of Respiratory Medicine, 7th Edition, 2023
16. The Acid Watcher Diet, 2nd Edition, Jonathan Aviv, MD, 2014, Hatherleigh Press
17. Dropping Acid: The Reflux Diet Cookbook & Cure, 1st Edition, Jamie Koufman, MD, and Jordan Stern, MD, 2012, Grand Central Life & Style