Acidity

The symptoms of acidity occur when some of the acid content of the stomach flows back up into the esophagus or the food pipe, which connects the mouth to the stomach. Normally, a ring of muscle called the lower esophageal sphincter (LES) acts as a valve that lets food enter the stomach but does not allow it back up into the esophagus. When this valve fails to function properly, stomach contents are regurgitated into the esophagus, leading to the following symptoms of acidity:

• Heartburn: Despite the name, heartburn has nothing to do with the heart. It is a common symptom of acidity caused when excess stomach acid leaks into the esophagus, leading to a burning sensation in the chest. This feeling can last for a few minutes to several hours.
• Regurgitation: Some people with acidity may experience regurgitation, which is the sensation of liquid undigested food, bile, or stomach acid moving up and down in the throat. This sensation is similar to feeling nauseous and usually occurs after meals, during exercise, or when bending right after eating.
• Sour taste in the mouth: A sour taste in the mouth is another common symptom of acidity. It occurs when food, along with stomach acid and bile, rises to the back of the throat, causing a bitter taste. This usually happens alongside regurgitation.
• Difficulty in swallowing: Difficulty in swallowing, also known as dysphagia, occurs when excess acid in the stomach creates a feeling of fullness. It can delay the movement of food through the esophagus and impede digestion.
• Sore throat: When stomach acid moves up to the mouth, it can irritate the vocal cords or voice box, leading to a sore throat or hoarseness.
• Indigestion: Indigestion, or dyspepsia, can also be a key sign of acidity and other digestive problems. It can result in discomfort and a burning sensation in the upper middle part of the stomach.

Heartburn is often confused with a symptom of a heart attack. Read the article to know the difference between angina, heartburn, and heart attack.

The stomach produces gastric acids that help in digesting food. However, due to certain factors, there are times when gastric acids are produced in excess, leading to acidity. Factors affecting the function of the lower esophageal sphincter (LES) are also responsible for acid reflux.

Some of the common causes of acidity include:

1. Food and dietary factors
   • Eating foods containing excessive amounts of chillies, pepper, vinegar, and paprika
   • Deep fried and oily foods
   • Excessive intake of caffeine in the form of tea, coffee, and chocolate
   • High intake of table salt
   • Diet low in fiber
   • Overeating or eating at irregular intervals
   • Unhealthy habits, like lying down just after eating
   • Eating just before strenuous physical exercise
2. Lifestyle factors
   • Frequent smoking
   • Excessive intake of alcohol, soda, or carbonated drinks
   • Lack of sleep
   • Lack of physical activity
3. Ailments and medications
   • Excessive stress, anxiety, or depression
   • Stomach diseases, like peptic ulcer, gastroesophageal reflux disease, and stomach cancer
   • Medications, like painkillers, antibiotics, chemotherapy medications, and antidepressants

• Medical conditions, such as asthma, diabetes, celiac disease, and connective tissue disorders like scleroderma
• Hiatal hernia
• Delayed stomach emptying
• Overweight/Obesity
• Pregnancy
• Women who are nearing menopause
• Women on hormone replacement therapy

If you experience any symptoms of acidity, such as burning pain or discomfort (also called heartburn), regurgitation, bloating, or burping (with a sour taste in the mouth), it is advisable to consult a doctor. Your doctor might conduct a physical examination followed by questions related to your daily routine to determine the cause of your symptoms.

If your symptoms are mild, your doctor might not recommend any tests. However, if your symptoms do not improve after treatment or if you experience symptoms such as internal bleeding or difficulty swallowing, further investigation may be necessary. The tests include:

• Upper GI endoscopy: A small flexible tube (known as an endoscope) is inserted down the throat to examine the lining of the esophagus, stomach, and small intestine.
• pH monitoring: This test measures stomach acid by checking how much acid enters the food pipe and how long it remains in the stomach.
• Barium swallow test (esophagram): You will need to drink a liquid barium mixture and undergo an X-ray of the chest and upper abdomen to identify any physical abnormalities in the stomach or esophagus.
• Esophageal manometry: This test checks the function of the lower esophageal sphincter (LES) and the muscles of the esophagus, determining if food can move through the esophagus normally.
• Electrocardiogram (ECG): In some cases, an ECG is recommended if you report severe chest pain or discomfort to evaluate your heart condition. Additionally, other tests, such as a biopsy, may be recommended based on your condition and symptoms.

There are few simple tips and tricks that can help you to prevent and manage acidity. These include:

• Eat small, frequent meals: One of the simple tips to lower your risk of acid reflux is to eat small yet frequent meals. This is because overeating puts extra pressure on the lower esophageal sphincter (LES), a valve-like muscle that prevents the acid content in the stomach from entering the esophagus.
• Eat a low-carb diet: A study has reported that a low-carb diet can improve heartburn symptoms, especially in obese individuals. Excess carbohydrates can make you gassy and bloated, which in turn can lead to heartburn.
• Chew your food properly: When you eat slowly and chew your food properly, it provides sufficient time for the digestive juices to break down the food. This can help you beat indigestion, acidity, and heartburn.
• Avoid eating late at night: Unhealthy eating habits are one of the leading causes of digestion-related problems. Eating late at night or snacking heavily in the evening can make you more prone to heartburn. Therefore, avoid late-night snacking or eating close to bedtime.
• Limit consumption of spicy and deep-fried foods: Regular intake of highly spicy food can stimulate excessive gastric acid production. Similarly, deep-fried foods are slow to digest and trigger more acid production. Hence, these kinds of food should always be consumed in moderation.
• Limit caffeine and carbonated beverages intake: One of the key ways to prevent heartburn is to avoid foods that trigger acid reflux. Caffeine-containing food and drinks, like tea or coffee, are highly acidic and stimulate excessive gastric acid production. Likewise, carbonated beverages increase acidity because carbonation bubbles expand in the stomach and put pressure on the LES, causing regurgitation of gastric acid.
• Limit your alcohol intake: Drinking alcohol is detrimental to your health, especially if you suffer from heartburn. Alcohol increases your risk of acid reflux and worsens the condition by irritating the lining of the stomach and impairing the LES's ability to clear acid. Hence, avoid alcohol to ease the symptoms of heartburn.
• Quit smoking: Nicotine in cigarettes can relax the LES and trigger acidity. For the prevention of acidity and many other health benefits, it is advisable to quit smoking. Tobacco is injurious to health.
• Avoid strenuous physical activity right after eating: Strenuous physical activities like exercising or bending right after meals can hinder digestion and lead to a build-up of acid in the esophagus. Give your stomach some time to empty its contents before exercising.
• Do not sleep immediately after meals: Maintain a gap of at least three hours between eating and sleeping. Lying down immediately after eating can increase pressure on the LES, making you vulnerable to acid reflux. A gap allows the stomach to digest food and prevent heartburn.
• Raise the head of the bed: Elevating the head of the bed by about 15-20 cm can reduce symptoms of acidity and improve sleep quality. This can be achieved using a foam wedge to support the upper body, as stacking pillows may not provide adequate support.
• Try to lose weight: If you are overweight and suffer from acid reflux, losing weight should be a priority. Excess fat, especially in the abdominal region, puts pressure on the stomach and the LES, pushing stomach acid upwards, leading to acid reflux.
• Check your medicines: Certain medicines can cause acid buildup or inflame the esophagus, leading to heartburn or worsening the condition. Talk to your doctor about the medicines you are prescribed to be aware of potential side effects such as heartburn.

The medications used to treat heartburn work either by blocking the production or aiding in the neutralization of stomach acid. Based on their action mechanism, these drugs are classified into three main categories:

1. Antacids

Antacids, also known as stomach acid neutralizers, neutralize stomach acid to provide quick relief from acidity. These are available in the form of tablets as well as syrups. Examples include:

• Aluminum hydroxide
• Magnesium hydroxide
• Magnesium trisilicate
• Magnesium carbonate
• Calcium carbonate

The side effects of antacids depend on their ingredients. For example, antacids containing aluminum hydroxide may cause constipation, while those containing magnesium hydroxide can lead to diarrhea. Long-term effects may include gas (belching), swelling of the feet and hands, constipation, and diarrhea.

2. H2-receptor blockers

These medications block specific receptors on stomach cells that release gastric acids, thereby helping to combat acidity. They also aid in the treatment of damaged tissues in the stomach caused by peptic ulcers, gastritis, or stomach inflammation.

Common side effects of H2-receptor blockers include abdominal pain and diarrhea. These drugs should not be taken by pregnant women as they may cause abortion and teratogenic (fetal defects) side effects. Examples include:

• Famotidine
• Ranitidine
• Nizatidine

3. Proton pump inhibitors (PPIs)

PPIs block and reduce the production of stomach acid to relieve acidity. They are available both as over-the-counter and prescription drugs. These drugs are usually prescribed to individuals who do not show improvement after diet and lifestyle changes or experience gastric symptoms regularly.

Side effects of these medications are rare but may include headache, diarrhea, and upset stomach. The long-term health effects of these medicines are not yet known, so consult your doctor if you are taking PPIs for an extended period or in high doses. Examples include:

• Omeprazole
• Pantoprazole
• Rabeprazole
• Esomeprazole
• Lansoprazole

4. Coating drugs

Coating drugs, also known as ulcer protective drugs, protect the esophagus and stomach by forming a protective layer over the surface. These drugs are primarily recommended for short-term action and are considered safe. They are often prescribed for individuals suffering from stomach ulcers and peptic ulcer disease. Examples include:

• Sucralfate
• Carbenoxolone
• Colloidal bismuth (CBS)

5. Prokinetic drugs

This class of prescription drugs promotes normal contraction of the esophagus and assists in the emptying of the stomach. They are commonly recommended for individuals with GERD and are often used in combination with medications that lower acid production in the body, such as PPIs and H2-receptor blockers.

Common side effects of these drugs include diarrhea, drowsiness, and agitation. Examples of prokinetic drugs include:

• Domperidone
• Metoclopramide
• Mosapride
• Levosulpiride

Diet plays a key role in managing and treating acidity. Here are some dos and don’ts you need to follow to keep your acid reflux under control and fight acidity.

Dos:

• Eat foods rich in fiber, as fiber aids in the process of digestion.
• Have small, frequent meals throughout the day to avoid excessive acid secretion.
• Water is the best natural remedy for acidity. Aim to consume close to 7-8 glasses (2-3 liters) of water every day.
• Include foods such as oatmeal, ginger, salad, banana, melon, and fennel seeds in your daily diet.
• Herbs, such as cardamom and mint, provide immediate relief from acidity and associated pain.

Don’ts:

• Avoid excessive intake of oily and spicy foods.
• Avoid excessive intake of caffeinated drinks, such as tea and coffee.
• Say no to alcohol and carbonated beverages.
• Do not overeat, as it puts a direct load on the digestion process and causes the body to secrete acid in excess.

Acid reflux or acidity usually does not cause any serious or long-term health problems when it occurs on an occasional basis. However, if it happens frequently and is left unattended, it can lead to various stomach problems, such as:

• Gastroesophageal reflux disease (GERD): This condition affects the lower esophageal sphincter (LES), a ring of muscle between the esophagus and stomach. Acidity or heartburn is one of the most common symptoms of GERD.
• Erosive esophagitis: This condition involves inflammation in the esophagus, which may lead to ulcers and bleeding.
• Ulcers: Untreated acidity can lead to stomach ulcers, increasing the risk of peptic ulcer disease.
• Barrett’s esophagus: In this condition, tissue similar to the lining of the intestine replaces the esophageal lining, which can increase the risk of esophageal cancer.
• Esophageal stricture: This condition causes the esophagus to narrow, leading to difficulties with swallowing.

Home remedies for acidity

Here are a few quick fixes to control and get relief from acidity:

• Holy basil (Tulsi) leaves: Tulsi leaves have antiulcer properties that help lower the acid level in the stomach. They also stimulate the stomach to produce more mucus, thus neutralizing excess gastric acid. Chew 4-5 leaves and swallow their juice to combat the burning sensation in the stomach and chest.
• Cinnamon (Dalchini): Cinnamon contains phytochemicals that assist in digestion, relieving acidity. Add a pinch of cinnamon powder to a teaspoon of honey or water and consume it after meals to eliminate acidity.
• Cumin seeds (Jeera): Jeera seeds contain compounds that act as natural carminative and digestive agents, aiding in the relief of acidity caused by indigestion and flatulence. These seeds also help alleviate symptoms of acidity, such as stomach pain and discomfort. Add 1/4-1/2 teaspoon of cumin seeds to a cup of water, boil until the water turns slightly dark, strain, cool, and sip this tea throughout the day if you experience frequent bouts of acidity.
• Cold milk (Doodh): Milk is high in calcium, a mineral that plays a key role in preventing acid buildup in the body, providing immediate relief. It absorbs excess acid produced in the stomach, nullifying its effect on the intestinal lining. It is advised to drink cold (not warm) milk to relieve acidity. Remember to drink it plain, avoiding additions like honey, sugar, or turmeric.
• Buttermilk (Chaach): Buttermilk neutralizes excess acid in the stomach and contains lactic acid, which improves digestion and helps combat acid reflux and gas. Drink a glass of buttermilk every day after meals if you are prone to frequent acid attacks. You can also add a pinch of black pepper and coriander.
• Carom seeds (Ajwain): Ajwain contains thymol, a compound that helps secrete gastric juices, easing indigestion and gas. Add a teaspoon of ajwain seeds or 3-4 fresh ajwain leaves to 2-3 glasses of water and boil. Strain and drink this water regularly after meals for quick relief.

Yoga for acidity

Some simple yoga asanas that can help relieve acidity include:

• Pawanmuktasana
• Vajrasana
• Virabhadrasana
• Shashankasana
• Trikonasana

If you experience acidity once in a while, it can be managed with a few lifestyle changes and diet modifications. However, if you suffer from chronic acidity, in addition to diet and lifestyle changes, you may also need to take medications to manage and prevent any long-term complications. If you are taking over-the-counter medications, it is wise to talk to your doctor to understand the severity of your condition and the appropriate treatment approach to prevent the acidity from worsening.

Here are a few changes that can help you manage and prevent acidity:

• Avoid foods that can trigger and worsen symptoms of hyperacidity, such as coffee, chocolate, carbonated drinks, deep-fried food, fat-rich dairy, meats, citrus fruits, and alcohol.
• Avoid eating right before bed and going to bed with a full stomach.
• Say no to large meals. Eat small and frequent meals.
• Drink more water and shed some weight if you are overweight or obese.
• Keep a diary to record your triggers and work on them to prevent another episode of acidity.
• Try home remedies or over-the-counter antacid medications if you experience symptoms of acidity.

Remember, chronic acidity can also indicate an underlying health problem, such as gastroesophageal reflux disease (GERD). Therefore, consult your doctor if your symptoms fail to subside with medications and at-home treatment.

Heartburn vs Acid reflux vs GERD

Although used interchangeably, these three terms have different meanings:

• Acid reflux, also known as acidity, is a digestive disorder characterized by excess acid levels in the stomach.
• Heartburn is a symptom of acidity or acid reflux that occurs when excess stomach acid leaks into the esophagus, leading to a burning sensation in the chest. This feeling can last for a few minutes to several hours.
• Gastroesophageal reflux disease (GERD) is a chronic form of acidity in which stomach acid causes inflammation of the esophagus and/or intestinal lining. You may require medications to neutralize or stop the production of acid in the stomach to treat this condition.

Heartburn in pregnancy

Heartburn is one of the most common gastrointestinal symptoms in pregnant women, with an incidence of 17% to 45%. The cause of heartburn during pregnancy is multifactorial. It is attributed to the increase in levels of the hormone progesterone or its metabolites, which cause the relaxation of smooth muscles and a decrease in lower esophageal sphincter pressure. Additionally, during pregnancy, food and gastric acid tend to pass from the stomach into the esophagus, leading to inflammation and a burning sensation. The pressure of the growing uterus on gastric contents as the pregnancy progresses may also worsen heartburn. Most cases of heartburn can be improved with lifestyle modifications, such as consuming smaller meals, not eating late at night, avoiding known triggers, and cessation of smoking or alcohol during pregnancy. If not relieved, your doctor may recommend medications that are safe for use during pregnancy.