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 is caused due to excess production of acid in the stomach by the gastric glands.

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 such as gastroesophageal reflux disease, tumors, 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 pathogenesis of acidity, also known as gastroesophageal reflux disease (GERD), is multifactorial and involves several 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 occurs when the upper part of the stomach pushes through the diaphragm into the chest cavity. 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. If these mechanisms are impaired, acid can linger in the esophagus and cause damage. [7]

Delayed Gastric Emptying:

• If the stomach empties slowly, it increases the volume and pressure of stomach contents, which can promote reflux.

Increased Gastric Acid Production:

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

Duodenogastroesophageal Reflux:

• In addition to acid, reflux of bile and other duodenal contents can also damage the esophageal mucosa and contribute to GERD symptoms.

Genetic Predisposition:

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

Pathophysiology:

The food we eat goes into our stomach through the esophagus. Moreover, 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. This condition is commonly known as acidity. Heartburn symptoms can start up because of a problem with a muscular valve called the lower esophageal sphincter (LES).

Location of LES:

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

Normally, with the help of gravity, the LES keeps stomach acid right where it should be — in your stomach. When it’s working right, the LES opens to allow food into your stomach or to let you belch, then closes again. But if the LES opens too often or doesn’t close tightly enough, stomach acid can seep into the esophagus and cause a burning sensation. If your LES doesn’t tighten as it should, there are often two things that contribute to the problem.

• 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:

• Antacid that contains aluminum, calcium, or magnesium
• Your doctor may also suggest the use of histamine blocking agents (H2 receptor blockers) such as cimetidine, nizatidine, ranitidine, also famotidine
• If the condition is severe, they may prescribe proton pump inhibitors
• If the condition is extremely severe, your doctor may suggest Vagotomy surgery that helps to reduce the production of acid in the stomach.[3]

Prevention:

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.

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:

Homeopathy being an individualistic science tries to find an individual remedy for each case. In Homeopathy, we boost the immune system which plays a very important role in natural elimination of disease organism or the disease itself and also in prevention. Homeopathic prescriptions are based on the nature and also depend upon the patient’s constitution. The treatment can give permanent relief to recurrent Heart Burn or Acidity. Following are some of the remedy that may help in cases of acidity or heart burn but it should not be used without a good homoeopathic physicians guidance.

Homeopathic medicine:

AMMONIUM CARBONICUM:

Pain in pit of stomach, with heartburn, nausea, waterbrash and chilliness flatulent dyspepsia Worse – evenings and during 3 to 4 a.m. Better – lying in painful side and on 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:

Dyspepsia due to farinaceous (corn, nut, meat, flour) and fermentable food, cabbage etc. Sour eructation’s incomplete burning eructation rise only to pharynx – burns for hours. Rolling of flatulence eating little creates fullness. Worse – 4-8 pm; right side. Better – warm drinks and food. [2]

NATRUM MURIATICUM:

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

NUX VOMICA:

Sour taste and nausea after eating. Weight and pain in stomach. Flatulence and pyosis (heartburn). Sour bitter eructations. Ravenous hunger especially before an attack of dyspepsia. Region of stomach, very sensitive – bloated, with pressure several hours after eating. Desire for stimulants. Dyspepsia from drinking strong coffee. Difficult belching of gas. Wants to vomit, but cannot. Worse – stimulants, alcohol, rich foods.

PULSATILLA:

Eructations bitter taste pain as from ulcer. Flatulence. Averse to fatty foods, warm food and drink. Heartburn and Acidity, dyspepsia with great tightness after a meal. Thirstlessness. Pain in stomach, shortly after eating. Vomiting of food eaten a long time before. Weight as from a stone, especially in morning on awakening waterbrash, four tastes in morning, painful distended abdomen. Worse – heat, rich fat food, after eating. Better – cold foot 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:

Nausea and faintness when rising up. Vomiting of bile and water immediately after eating. Worse warm drinks, which are vomited. Stomach sensitive to touch. Dyspeptic ailments during summer heat. Epigastrium sensitive to touch. Worse – morning, eating, hot weather. Better – cold things.

CONIUM:

Terrible nausea, acid heartburn, and acid eructations. Worse on going to bed. Moreover, Amelioration from eating with aggravation a few hours after meals. Acidity and burning. Also, Painful spot at the level of the sternum.

CAPSICUM:

Burning in tip of tongue. Atonic dyspepsia. Much flatulence, especially in debilitated subjects. Intense craving for stimulants. Vomiting, sinking at pit of stomach. Much thirst; but drinking causes shuddering. Burning from mouth to rectum.[2]

Diet & Regimen

Acidity is a common problem that most of us face at least once in our life. Most of us prefer home remedies over medications. Some of the home remedies for acid reflux include the following.

Coconut water:

• This tasty treat is known to soothe your stomach and the digestive system. Specifically, Take at least two glasses a day.

Watermelon juice:

• It is great to counter acidity. In addition, You can take a glass of watermelon juice with breakfast.

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