Acidity

Acidity often starts with a burn in your chest after a heavy meal, or maybe when you lie down soon after eating. That sharp, rising discomfort could be acidity.

Acidity happens when the acid in your stomach flows back into your food pipe (oesophagus), irritating its lining (Azer et al., 2024). You might know it as heartburn or acid reflux. Spicy food, oily meals, long gaps between meals, stress, or even certain medications can make it worse.

While an occasional episode is common, if you're feeling these symptoms more than twice a week, it may be more than just a passing issue. It could be a sign of chronic acid reflux or GERD. If that sounds like you, it’s worth speaking to a doctor, because with the right treatment, relief is possible.

How Does Acidity Occur?

Unhealthy eating habits, such as consuming spicy or oily foods, irregular meal patterns, and overeating, often trigger it. Lifestyle factors such as stress, smoking, and lack of exercise also contribute. Managing diet and improving lifestyle can help manage acidity effectively. (Bhatia et al., 2019).

The following are common symptoms of acidity (Azer et al., 2024):

1. Heartburn

Heartburn is a burning feeling in the chest, often occurring after eating or when lying down. It happens due to stomach acid flowing back into the food pipe.

2. Dyspepsia

Dyspepsia refers to discomfort or pain in the upper abdomen, often described as a feeling of fullness, tightness, or mild burning.

3. Bloating 

Bloating is the uncomfortable sensation of an empty or overstretched stomach, which is usually caused by gas or indigestion.

4. Difficulty Swallowing 

This symptom makes it feel like food is getting stuck in the throat or chest, often due to irritation or narrowing of the oesophagus.

5. Regurgitation 

Regurgitation is the sour or bitter taste in the mouth caused by stomach contents flowing back up into the throat, typically from a weak oesophageal sphincter.

6. Nausea 

Nausea is a queasy sensation with an urge to vomit, usually triggered by excess stomach acid irritating the stomach lining.

7. Burping 

Burping is the expulsion of gas from the stomach through the mouth, often occurring after eating or drinking, and is a common sign of acidity.

Acidity is a widespread concern in India, affecting a large segment of the population. Research shows that the prevalence of GERD (Gastroesophageal Reflux Disease), a chronic form of acidity, ranges between 7.6% and 30% across different urban regions in the country, highlighting its growing impact on public health.

Stage 1: Mild GERD

At this stage, acid reflux is occasional, usually once or twice a month. Symptoms are generally mild and can be controlled with lifestyle adjustments, dietary changes, and occasional over-the-counter medications.

Stage 2: Moderate GERD

Moderate GERD involves more frequent symptoms that may interfere with daily life. Patients typically need daily prescription medications to manage discomfort and prevent complications.

Stage 3: Severe GERD

Symptoms are persistent and painful, even with prescription treatments. At this stage, GERD significantly affects daily functioning, and surgery may be recommended for long-term relief.

Stage 4: Precancerous or Cancerous GERD

Barrett's oesophagus, a precancerous condition where the oesophageal lining changes due to chronic acidity, affects only 5% to 12% of people with GERD. While Barrett's itself is not cancerous, it significantly increases the risk of oesophageal adenocarcinoma. The risk of developing oesophageal cancer is low, but managing GERD and monitoring for Barrett's through regular checkups is crucial to prevent progression. 

How does GERD affect the body?

GERD can affect multiple organ systems (Azer et al., 2024):

• Oesophagus: GERD most directly affects the oesophagus, where repeated exposure to stomach acid causes inflammation, pain, and damage known as esophagitis. 
• Throat and Voice Box (Larynx): Stomach acid can travel up into the throat and voice box, causing irritation known as laryngopharyngeal reflux (LPR). 
• Mouth and Teeth: Acid reflux can also reach the mouth, where it erodes tooth enamel, making teeth more sensitive and prone to decay. 
• Lungs and Airways: In some cases, acid can be inhaled into the lungs, leading to respiratory issues like chronic cough, asthma, wheezing, or even recurrent pneumonia. 
• Chest Area: GERD may cause sharp or burning chest pain that mimics heart-related conditions. This discomfort is due to acid-induced inflammation and spasms in the oesophagus.

Gastric acids are produced in the stomach to help with food digestion. However, sometimes the stomach produces excess acid due to various factors, leading to acidity. Causes of frequent acidity include when the lower oesophageal sphincter (LES), the muscle that prevents acid from flowing back into the oesophagus, does not function properly.

Common features of acidity include some of the following:

• Unhealthy Eating Habits: Irregular meal timings, skipping meals, or eating right before bedtime can trigger acidity. Diets high in spicy foods, salt, or low in fibre further aggravate the condition by increasing acid production and slowing digestion.
• Excessive Intake of Certain Foods and Drinks: Overconsumption of tea, coffee, aerated drinks, soft drinks, spicy meals, and fatty foods like fried snacks and fast food can irritate the stomach lining and promote acid reflux.
• Side Effects of Medications: Certain medications may contribute to acidity, including non-steroidal anti-inflammatory drugs (NSAIDs), blood pressure medicines, and antibiotics.
• Digestive Disorders: Underlying gastrointestinal issues like peptic ulcers, GERD (gastroesophageal reflux disease), or even stomach tumours can impair digestion and increase stomach acid, leading to frequent acidity
• Smoking: Smoking weakens the lower oesophageal sphincter (LES), the valve that keeps stomach acid from flowing back into the oesophagus. A weakened LES allows acid to escape more easily, causing heartburn. Studies indicate smokers are 1.7 times more likely to get acidity than nonsmokers.
• Stress: High emotional stress can stimulate excess acid production and worsen reflux symptoms, especially in people with GERD. It also affects the normal functioning of the LES.
• Alcohol Consumption: Drinking alcohol can trigger acid reflux by relaxing the LES and increasing acid production in the stomach. 
• Poor Sleep: Due to Poor Sleep, Inadequate sleep may increase oesophageal acid sensitivity.  Acid reflux at night is more powerful and protracted than during the day, causing more discomfort.

Which food causes acidity?

The following foods are commonly associated with triggering acid reflux (Surdea-Blaga et al., 2017):

1. Fast Food: Fast food items that are fried or high in fat can trigger acid reflux. These foods relax the oesophageal sphincter and slow down stomach emptying, making it easier for stomach acid to flow back into the oesophagus.

2. Dairy Products: Dairy products made from cow’s milk, like cheese and whole milk, can worsen acid reflux symptoms. While they may not directly cause reflux, they often increase stomach discomfort and acidity in sensitive individuals.

3. Fatty Meats: Fatty meats such as beef, lamb, or pork take longer to digest, which delays stomach emptying. This can lead to increased acid buildup and reflux, especially due to the release of certain hormones that relax the oesophageal sphincter.

4. Citrus Fruits: Citrus fruits like oranges, lemons, and grapefruits are high in citric acid, which can stimulate excess stomach acid. This often results in a fuller stomach and raises the likelihood of acid reflux.

Acidity can affect individuals of any age and may sometimes occur without a clear reason. It is often linked to lifestyle habits or medical conditions that increase susceptibility.

Common Risk Factors:

• Obesity: Excess body weight puts pressure on the stomach, promoting acid reflux.
• Smoking (active or passive): Tobacco smoke weakens the oesophageal sphincter, allowing acid to escape into the oesophagus.
• Sedentary lifestyle: Lack of physical activity can slow digestion and increase acid buildup.
• Certain medications: Drugs for asthma, antihistamines, calcium-channel blockers, sedatives, painkillers, and antidepressants may contribute to acidity.
• Pregnancy: Hormonal changes and pressure on the stomach during pregnancy can trigger acid reflux.

Dietary and Eating Habits are Reasons for Acidity (Heartburn):

• Caffeine: Found in coffee, tea, and some sodas, caffeine can relax the lower oesophageal sphincter and allow acid to rise.
• Alcohol: Alcohol increases stomach acid production and weakens the oesophageal barrier.
• Fast food and processed food: High-fat, greasy, or heavily processed foods are difficult to digest and often trigger reflux.
• Spicy foods: These can irritate the stomach lining and increase acid production.
• Tomatoes and tomato-based sauces: Naturally acidic, they can worsen heartburn and reflux.
• Onions and garlic: These frequently make sensitive people's symptoms of acid reflux worse.
• Large meals: Overeating stretches the stomach and raises the likelihood of acid moving upward.
• Lying down soon after eating: Reclining within 2–3 hours of a meal can cause acid to backflow into the oesophagus.
• Excess chocolate, fizzy drinks, and acidic juices: These items relax the lower oesophageal sphincter and increase stomach acidity.

Who is at Risk?

People most at risk for acidity and GERD include those with excess weight, hiatal hernia, pregnancy, tobacco exposure, sedentary lifestyles, certain medications, and gastrointestinal or connective tissue disorders.

• Gastroesophageal Reflux Disease (GERD): GERD occurs when the lower oesophageal sphincter (LES), a muscle ring between the food pipe and stomach, weakens or malfunctions, causing frequent acid reflux or heartburn.
• Erosive Esophagitis: This condition refers to inflammation and damage in the oesophagus lining caused by repeated acid exposure, which may result in ulcers and even bleeding.
• Ulcers: If acidity is persistent and untreated, it can lead to painful sores in the stomach lining, known as ulcers, increasing the risk of peptic ulcer disease.
• Barrett’s Oesophagus: In this condition, the normal cells lining the oesophagus are replaced with cells similar to those in the intestines, potentially raising the risk of oesophageal cancer in some individuals.
• Oesophageal Stricture: Frequent acid reflux can cause scarring and narrowing of the oesophagus, making it difficult to swallow food comfortably.

• Quit Smoking: Stopping smoking helps reduce heartburn, as tobacco weakens the lower oesophageal sphincter and increases acid reflux risk.
• Eat Small, Frequent Meals: Smaller meals reduce stomach pressure and lessen the chance of acid pushing into the oesophagus.
• Avoid Trigger Foods: Certain items like fatty meats, spicy foods, tomatoes, citrus, chocolate, caffeine, carbonated drinks, garlic, onions, and alcohol increase acid production and should be avoided.
• Choose Healthy Foods: A diet rich in fruits, vegetables, and lean proteins with adequate water supports digestion and weight control, which lowers reflux risk.
• Don’t Lie Down After Eating: Stay upright for 2–3 hours post-meal to prevent acid from flowing back into the oesophagus.
• Elevate the Head While Sleeping: Raising the head of the bed or using a wedge pillow can prevent nighttime acid reflux by using gravity to keep acid down.
• Avoid Tight Clothing: Tight clothes around the abdomen increase pressure on the stomach and can worsen reflux symptoms.
• Track Your Triggers: Keeping a diary of foods and habits that cause reflux helps you avoid them and manage symptoms better.

The following criteria are used to diagnose acid reflux disease or heartburn.

• Physical Examination: A check-up is done to identify signs like weight loss, anaemia, or malnutrition, and to assess for lung-related complications from acid reflux.
• Endoscopy: An endoscope, a thin tube with a camera, is inserted into the oesophagus to visually inspect for damage, inflammation, or ulcers.
• Manometry: This test measures the strength and function of the lower oesophageal sphincter using a pressure-sensitive tube inserted into the oesophagus.
• pH Monitoring: A 24-hour pH test tracks acid levels in the oesophagus to confirm how often and how severely acid reflux occurs.
• Barium Swallow Test: A patient swallows a barium solution, which highlights the oesophagus in X-rays to detect muscle issues or blockages.
• Blood Tests: Basic blood tests help detect anaemia or nutrient deficiencies linked to poor absorption from prolonged acid reflux.

Heartburn medications work by either reducing the production of stomach acid or neutralising it. These drugs are generally classified into three main categories based on their mechanism of action.

Antacids provide quick relief by neutralising stomach acid and come in tablet or syrup form (Azer et al., 2024). Common examples include:

• Aluminium Hydroxide: Aluminium hydroxide is an antacid that neutralises excess stomach acid, offering quick relief from heartburn and indigestion.
• Magnesium Hydroxide: Also known as “milk of magnesia,” magnesium hydroxide neutralises stomach acid and acts as a laxative. It provides fast relief from acidity.
• Magnesium Trisilicate: This antacid neutralises gastric acid and forms a protective coating on the stomach lining, reducing irritation.
• Magnesium Carbonate: Magnesium carbonate helps relieve acid reflux and heartburn by neutralising stomach acid. 
• Calcium Carbonate: Calcium carbonate offers rapid and effective relief from acidity by directly neutralising gastric acid. It is commonly found in chewable tablets.

Note: Limit use of antacids to less than 2 weeks, separate dosing from other medications by more than 2 hours to prevent drug interactions.

Home Remedies For Acid Reflux

• Apple Cider Vinegar: Diluted apple cider vinegar (about one teaspoon in water) is helpful for acid reflux.
• Aloe Vera Juice: Aloe vera juice may soothe digestive irritation, though research doesn't confirm its benefit for acid reflux.
• Bananas: Bananas are low-acid and gentle on the stomach, and though they might not directly affect reflux.
• Baking Soda: Mixing a small amount of baking soda with water can temporarily neutralise stomach acid.
• Carom seeds (Ajwain): They contain thymol, a compound that stimulates the release of gastric juices, helping to relieve indigestion and gas.

Note: While home remedies may provide symptomatic relief, they should not replace medical treatment for persistent or severe symptoms. Consult your doctor before using home remedies, especially if you have underlying medical conditions.

Living with acidity requires mindful lifestyle choices and consistent management. It involves eating smaller, balanced meals, avoiding trigger foods like spicy or fatty items, staying upright after meals, and maintaining a healthy weight. Limiting caffeine, alcohol, and smoking is also essential. Stress reduction through practices like yoga or meditation can help prevent flare-ups. With regular habits and, if needed, medication under a doctor’s guidance, acidity can be effectively managed and quality of life maintained.

Expert opinion: Many patients ignore acidity until it starts disrupting sleep or daily meals. What begins as occasional heartburn can progress to GERD if not addressed early with the right treatment.

You should visit the doctor if: 

• You experience acidity or heartburn more than twice a week.
• Over-the-counter antacids don’t provide relief.
• Symptoms interfere with daily activities or sleep.
• You have trouble swallowing, persistent nausea, or vomiting.
• You notice unexplained weight loss, chest pain, or black stools (which may indicate internal bleeding).

• Occasional acidity is common and usually related to diet, stress, or irregular eating habits.
• Eat small, frequent meals, avoid spicy, oily, or late-night meals, and don’t lie down immediately after eating.
• Limit tea, coffee, alcohol, and smoking, which can trigger excess acid production.
• Stay hydrated and include fibre-rich foods like fruits and vegetables to aid digestion.
• If acidity is frequent (2 or more times a week) or causes severe discomfort, consult your doctor; it could signal an underlying problem like GERD or ulcers that needs treatment.
• Don’t ignore persistent symptoms like difficulty swallowing, unexplained weight loss, or black stools.