Acidity

• Symptoms: Burning sensation in the chest (heartburn), upper abdominal pain, Dysphagia or difficulty swallowing, ongoing cough especially at night, backwash or regurgitation of sour liquid and food, a sensation of a lump in the throat, asthma, vocal cords inflammation or laryngitis
• Causes: Consumption of spice, fried, or fatty food; eating chocolates and peppermint consumption, alcohol intake, consumption of carbonated beverages, drinking too much coffee or other caffeinated drinks, excess consumption of ketchup, presence of citrus food in the diet
• Risk Factors: specific food consumption, smoking, eating large meals, particular medication, drinking excess alcohol and coffee
• Severity: Mild, moderate, severe, pre-cancer
• Which doctor to consult: Gastroenterologists

Overview

Acidity is a term commonly used to describe the signs and symptoms of acid reflux, also known as gastroesophageal reflux or GER. It is sometimes mistaken for gastroesophageal reflux disease or GERD.

Acidity or GER occurs when the stomach contents go in the reverse direction and reach the oesophagus. In contrast, GERD is more severe. The chronic condition lasts longer than GER and results from repeated acidity.

Generally, acidity can be categorised into a few categories such as:

• Upright acid reflux 
• Supine acid reflux
• GERD

While upright and supine acid reflux are the generic types of acidity, GERD is the chronic version. Upright acid reflux can occur throughout the day, especially while sitting up. Supine acid reflux, in contrast, happens during the night when the acid flows toward the oesophagus. Usually, lying down can provide temporary relief, but it is advisable to consult a gastroenterologist in case of supine acid reflux.

GERD, or gastroesophageal reflux disease, can occur every hour and involves more severe complications such as sphincter malfunction. Due to the improper functioning of the lower esophageal sphincter (LES), the stomach contents can move upwards back into the throat and mouth, giving a sour taste.

Common symptoms of acidity include chest pain and sore throat. However, long-term damage can cause complications in the respiratory system and stomach.

When to Consult a Doctor?

Patients suffering from the signs and symptoms of acidity need to seek medical assistance under the following conditions:

On Symptoms: Usually, an individual should consult a gastroenterologist if he/she experiences severe chest pain or shortness of breath. Any discomfort in the jaw or numbness in the arm must also be brought under immediate medical attention. Other than that, any recurring symptoms of acidity that last for more than two weeks need to be examined by a gastroenterologist. If a person suffers from heartburn despite taking over-the-counter medicines, he/she must also get checked by a doctor.

Difficulty Swallowing: If a patient suffers from Dysphagia or has difficulty swallowing, he/she must consult a doctor. Acute Dysphagia is usually followed by regurgitation and frequent heartburn. All of these can be a sign of acid reflux, and a gastroenterologist can provide the proper diagnosis and treatment for the same.

Difficulty Breathing: GERD is a chronic disorder often associated with asthma, aspiration, and bronchospasm. It can become fatal if not given immediate medical assistance. The most common problem that occurs due to acid reflux is Dyspnea, as the stomach acid enters the lungs. This can occur during sleep and swell the airways, causing bouts of asthma or aspiration pneumonia. The outcome is sudden wheezing or coughing during sleep.

Diagnosis

Physical Examination: A gastroenterologist specialises in the digestive tract and can examine the signs and symptoms of acid reflux. The doctor will initially conduct a physical check-up to determine GER or GERD. This includes performing an oesophageal manometry for reflux testing and upper endoscopy. The oesophageal manometry confirms the proper functioning of the oesophagus, the long muscular tube connecting the throat to the stomach. For upper endoscopy, a flexible tube with a camera is inserted. It helps examine the oesophagus, stomach area, and small intestine. Patients are sedated while performing these tests.

Diagnostic Tests

Blood Tests: Anion gap blood tests are a way to check the pH balance in the blood. This test confirms whether the blood is too acidic and is performed along with the electrolyte panel test. This comprehensive examination confirms the presence of electrically charged minerals like sodium, potassium, and bicarbonate, which help regulate the acid-base balance in the blood.

Imaging Tests

Narrow-Band Imaging Test: Narrow-band imaging test helps better visualise the mucosal alteration due to GER or GERD. Doctors can inspect the mucosa minutely with the help of specific blue (410 nm) and green (540 nm) wavelengths from the standard white-light endoscope. The test also helps in examining blood vascular patterns and pit patterns.

Advanced Test

Impedance-pH Testing: Since the changes in the mucosa is not visible in most patients of GERD, the endoscopic assessment may not always be accurate. So, a 24-hour oesophageal pH metry is conducted to check the oesophagus acidity levels in 24 hours. Doctors may even use impedance technology to measure the amount of liquid and air going up and down the oesophagus. The test helps determine both acidic and non-acidic GERD.

Treatment

Home Care: In case the symptoms of acidity cause significant discomfort, an individual can temporarily subdue the symptoms with some home remedies. For instance, consuming one teaspoon of fennel powder with warm water can relieve symptoms like bloating. The mix is also seen to improve digestion. Another remedy is to chew a few cumin seeds and then drink a glass of water. An individual can boil a teaspoon of the seeds in water and then drink it as well. However, one must always consult a gastroenterologist before following these methods.

Medication

Prescription Medication: A doctor can prescribe some medicines to relieve the symptoms of GERD. These include:

• Proton pump inhibitors like esomeprazole, omeprazole, pantoprazole, rabeprazole, lansoprazole, and dexlansoprazole
• H-2 blockers like famotidine and nizatidine

While the prescription-strength H-2 blockers do not cause much side effects, proton pump inhibitors tend to cause nausea, headache, diarrhoea, and even low magnesium or B12 levels.

Non-prescription medication: A few non-prescription over-the-counter medications are available that patients can consume for temporary relief. Among these, antacids are the most common ones and help neutralise the acid in the stomach. However, over-consumption of antacids is never recommended as it can cause diarrhoea and kidney problems. Other non-prescription medications include histamine (H-2) blockers like Pepcid AC. However, these are less effective than antacids.

Surgical Treatment: Nissen Fundoplication is one of the most effective surgical procedures for treating GERD. During the surgery, a surgeon operates on the sphincter at the bottom of the oesophagus to control the acid reflux. Although the surgical method is shown to cure patients of the symptoms, it is often recommended as a last resort.

Risk and Complications if Left Untreated

If left untreated, GER can turn into acute GERD in the long run and cause many problems, especially to the oesophagus.

• Oesophagitis: Oesophagitis is an inflammation of the oesophagus and causes pain while swallowing. Chest pain is another common symptom of the disorder. H2-receptor blockers and proton pump inhibitors are the only medication that can provide relief in this situation.
• Barrett's Oesophagus: Untreated acid reflux can cause Barrett’s oesophagus syndrome. In this condition, the flat pink lining of the swallowing tube is damaged and thickened. The lower esophageal sphincter (LES), a vital connector between the stomach and the oesophagus, is severely damaged. As a result, acid and chemical regurgitation from the stomach damages the oesophagus, causing GERD. A typical long-term effect of Barrett's oesophagus is oesophageal cancer. In such cases, the doctor needs to examine the precancerous cells and remove them to prevent progress.

Additional Information

• Stages of GERD

1. Stage 1 – Mild GERD 
2. Stage 2- Moderate GERD
3. Stage 3 – Severe GERD
4. Stage 4 – Precancer or cancer

• Types of Acid Reflux

1. LPR or Laryngopharyngeal reflux
2. GERD

• How smoking affects acidity?

Smoking harms not only the respiratory system but also the digestive system. It has been seen that smokers tend to suffer from frequent heartburn and peptic ulcer than non-smokers. Diseases like Crohn's disease, and gallstones, also occur more frequently in smokers.

Smoking can weaken the oesophageal sphincter, which prevents the backwards flow of stomach acid. So, it is highly recommended to avoid smoking to control and reduce the chances of acid reflux and GERD.