Acidity, often referred to as acid indigestion or heartburn, is a common digestive symptom characterized by a burning sensation or discomfort in the chest or upper abdomen, typically behind the breastbone. Acidity occurs when stomach acid refluxes or regurgitates into the esophagus, leading to irritation and inflammation of the esophageal lining. While occasional episodes of acidity are normal and may occur after eating spicy or fatty foods, overeating, or lying down immediately after meals, frequent or persistent acidity symptoms may indicate underlying digestive disorders such as gastroesophageal reflux disease (GERD) or gastritis.
Symptoms of Acidity: The symptoms of acidity can vary in severity and frequency among individuals, but common symptoms may include:
Heartburn: A burning sensation or discomfort in the chest, often behind the breastbone, that may worsen after eating, lying down, or bending over. Heartburn is one of the hallmark symptoms of acidity and is caused by irritation of the esophageal lining by stomach acid.
Regurgitation: The sensation of acid reflux or sour-tasting fluid moving up into the throat or mouth, often accompanied by a bitter or acidic taste. Regurgitation may occur spontaneously or be triggered by bending over, lying down, or eating large meals.
Dyspepsia: Dyspepsia, also known as indigestion, refers to discomfort or pain in the upper abdomen, often described as a burning, gnawing, or bloating sensation. Dyspepsia may be accompanied by symptoms such as fullness, belching, nausea, or bloating.
Chest Pain: Chest pain or discomfort that may mimic symptoms of a heart attack, particularly in individuals with severe or atypical symptoms of acidity. Chest pain associated with acidity is typically non-cardiac in origin and may be relieved by antacids or changes in body position.
Sour or Bitter Taste: A sour or bitter taste in the mouth or throat, particularly after regurgitation of stomach acid or sour-tasting fluid into the esophagus.
Dysphagia: Difficulty swallowing or a sensation of food getting stuck in the throat or chest, particularly if inflammation or narrowing of the esophagus (esophageal stricture) develops due to chronic acid reflux.
Hoarseness or Sore Throat: Hoarseness, sore throat, or irritation of the throat due to acid reflux or regurgitation of stomach contents into the throat, larynx, or vocal cords.
Causes and Risk Factors of Acidity: Acidity occurs due to the reflux of stomach acid into the esophagus, which may be caused by various factors, including:
Weak or Relaxing Lower Esophageal Sphincter (LES): Dysfunction or weakening of the lower esophageal sphincter (LES), a ring of muscle that normally prevents stomach contents from refluxing into the esophagus, may allow acid reflux to occur more frequently or with greater severity.
Hiatal Hernia: A hiatal hernia occurs when a portion of the stomach protrudes through the diaphragm into the chest cavity, disrupting the normal anatomy and function of the LES and increasing the risk of acid reflux.
Dietary Factors: Certain dietary factors may contribute to acidity symptoms, including consumption of spicy or fatty foods, acidic foods or beverages (e.g., citrus fruits, tomatoes, coffee, alcohol), chocolate, peppermint, or carbonated beverages.
Obesity or Excess Weight: Excess body weight, particularly abdominal obesity, can increase intra-abdominal pressure and put pressure on the stomach, leading to acid reflux and acidity symptoms.
Smoking: Smoking tobacco or exposure to secondhand smoke can weaken the LES, impair esophageal motility, and increase the production of stomach acid, leading to an increased risk of acidity.
Pregnancy: Hormonal changes, increased intra-abdominal pressure, and mechanical factors associated with pregnancy can contribute to the development or exacerbation of acidity symptoms in pregnant women, particularly during the third trimester.
Certain Medications: Some medications may increase the risk of acidity or exacerbate symptoms by relaxing the LES, increasing stomach acid production, or causing irritation of the esophageal lining. These may include nonsteroidal anti-inflammatory drugs (NSAIDs), aspirin, certain blood pressure medications (e.g., calcium channel blockers), sedatives, antidepressants, or medications for asthma or allergies.
Delayed Gastric Emptying: Delayed gastric emptying (gastroparesis) or impaired stomach motility can lead to an accumulation of stomach contents and increased gastric pressure, predisposing to acid reflux and acidity symptoms.
Diagnosis of Acidity: Diagnosis of acidity is typically based on a combination of clinical evaluation, medical history, symptom assessment, physical examination, and diagnostic tests to evaluate the presence and severity of acid reflux and assess for complications. Diagnostic tests for acidity may include:
Symptom Assessment: Evaluation of typical acidity symptoms such as heartburn, regurgitation, chest pain, or difficulty swallowing, as well as assessment of symptom frequency, severity, duration, and triggers.
Upper Endoscopy (EGD): Upper endoscopy or esophagogastroduodenoscopy (EGD) may be performed to visualize the esophagus, stomach, and upper gastrointestinal tract, assess for signs of inflammation, erosions, ulcers, strictures, or Barrett’s esophagus, and obtain biopsies if needed.
Esophageal pH Monitoring: Esophageal pH monitoring, including ambulatory pH monitoring (pH probe study) or wireless pH monitoring (Bravo capsule), may be used to measure acid reflux episodes, assess esophageal pH levels, and correlate symptoms with acid reflux events over a 24-hour period.
Esophageal Manometry: Esophageal manometry may be performed to evaluate esophageal motility, assess LES function and relaxation, and rule out other esophageal motility disorders or dysmotility syndromes.
Barium Swallow: Barium swallow or upper gastrointestinal series may be used to visualize the esophagus, stomach, and upper digestive tract using X-rays after ingestion of a contrast agent (barium), allowing assessment of anatomical abnormalities, strictures, or hiatal hernia.
Laboratory Tests: Laboratory tests such as complete blood count (CBC), comprehensive metabolic panel (CMP), or fecal occult blood test (FOBT) may be ordered to evaluate for anemia, electrolyte imbalances, or other abnormalities associated with acidity or its complications.
Treatment of Acidity: Treatment of acidity aims to alleviate symptoms, reduce the frequency and severity of acid reflux, promote healing of esophageal inflammation or erosions, and prevent complications. Treatment options for acidity may include:
Antacids: Over-the-counter antacid medications such as calcium carbonate (e.g., Tums), magnesium hydroxide (e.g., Maalox), or aluminum hydroxide (e.g., Mylanta) may be used to neutralize stomach acid and provide rapid relief of heartburn or acid reflux symptoms.
Histamine H2 Receptor Antagonists: Histamine H2 receptor antagonists such as ranitidine (Zantac), famotidine (Pepcid), or cimetidine (Tagamet) may be used to reduce gastric acid secretion and alleviate symptoms of acidity, although they are less effective than proton pump inhibitors (PPIs) for healing esophagitis or preventing complications.
Proton Pump Inhibitors (PPIs): Proton pump inhibitors such as omeprazole (Prilosec), esomeprazole (Nexium), lansoprazole (Prevacid), pantoprazole (Protonix), or rabeprazole (Aciphex) are the mainstay of treatment for acidity and work by inhibiting gastric acid secretion, promoting healing of esophageal mucosa, and preventing acid-related complications.
Dietary and Lifestyle Modifications: Lifestyle modifications such as avoiding trigger foods or beverages, eating smaller meals, avoiding lying down or bending over immediately after meals, elevating the head of the bed during sleep, maintaining a healthy weight, quitting smoking, and reducing stress may help reduce symptoms of acidity and prevent acid reflux episodes.
Medication Adjustments: Adjustments to medications that may exacerbate acidity symptoms, such as NSAIDs, aspirin, or certain blood pressure medications, may be recommended in consultation with a healthcare provider.
Surgical Interventions: In severe or refractory cases of acidity that do not respond to medical therapy or lifestyle modifications, surgical interventions such as laparoscopic fundoplication or placement of a LINX Reflux Management System may be considered to reinforce the LES and prevent reflux.
Monitoring and Follow-Up: Regular monitoring and follow-up care with a healthcare provider, such as a gastroenterologist or primary care physician, are important for individuals with acidity to assess treatment response, monitor symptom control, evaluate for complications, and adjust treatment as needed. Long-term management of acidity may involve periodic evaluations, medication adjustments, lifestyle modifications, and ongoing support to optimize outcomes and improve quality of life.
Prognosis: The prognosis of acidity is generally good with appropriate treatment and management, as most individuals experience significant symptom relief and improvement in quality of life with medical therapy, lifestyle modifications, or surgical interventions. However, untreated or poorly controlled acidity can lead to complications such as esophagitis, strictures, Barrett’s esophagus, or esophageal adenocarcinoma over time, highlighting the importance of early diagnosis, prompt treatment, and regular monitoring for individuals with acidity.
