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Understanding Acidity

Acidity, acid reflux or Gastroesophageal reflux is when stomach contents move backwards into the esophagus (food pipe). This is said to become Gastroesophageal reflux disease (GERD), when the reflux of stomach contents causes troublesome symptoms and/or complications. Symptoms include heartburn and (nocturnal) regurgitation (bringing up of stomach contents), in addition to difficulty swallowing, asthma and cough among others.

A Brief Background

It is a good idea to understand briefly, how acid is generated in the stomach.

  • The sight, sound, smell, anticipation and the beginning of oral ingestion of food causes the activation of various digestion-related mechanisms, including stomach acid secretion. (cephalic, oral phases)
  • When the stomach stretches due to the presence of food or liquid, or the presence of protein is sensed, secretion of stomach acids begin, as well as activation of mechanisms to control the amount of acid release and regulate acidity (ph) levels. 50-60% of meal-stimulated acid secretion happens now. Protein digestion begins. (gastric phase)
  • When the stomach contents reach the intestine, major chemical and physical changes happen to the food, and digestion continues, including outcomes such as absorption of nutrients. (intestinal phase)

A Few GERD Facts

  • Equally prevalent among men and women.
  • Incidence increases with age
  • Most often found in pregnant women
  • More prevalent in western countries
  • Increased occurrence when overweight or obese
  • Inversely co-related to incidence of H. pylori (controversial)
Image source: Medical News Today. Annotated for clarity.

Causes of GERD

  • Primary cause is when the Lower Esophageal Sphincter (LES) fails to keep gastric acid out of the esophagus.
  • This could further be due to any agent that decreases LES pressure or a condition that increases intra-abdominal pressure.
  • Hiatal hernia with incompetent sphincter

What To Do

The following suggestions may help reduce symptoms.

  • Avoid late night meals
  • Avoid lying down for several hours after a meal
  • Elevating the head by 6-8 inches
  • Avoid food and drink that worsens the condition. These are typically, alcohol, caffeine, chocolate and mints, in addition to fatty and spicy foods.
  • Eat while upright, instead of lying down or reclined.
  • Eat small, frequent meals instead of less frequent large ones
  • After eating, avoid tight clothing, vigorous exercise, bending, straining etc.
  • Smokers should consider quitting.

Further Reading

This is a good article to read for additional information. WebMD has a short list of foods that cause acidity.

References:

  1. Yamada’s Textbook of Gastroenterology, 6th Edition
  2. Taber’s Cyclopedic Medical Dictionary, 23rd Edition

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