Acidity-Causes,Treatment and Prevention

 Acidity-Causes,Treatment and Prevention

Hydrochloric acid is normally secreted in our stomach by specialized cells in response to food intake. It is an important constituent of digestive juices.

Its functions include:
1. Activation of protein digesting enzyme.
2. Acts as protection against bacteria.
3. Provides acidic medium for digestion and absorption of certain nutrients.



Our stomach and duodenum (the first part of small intestine) is protected from the severity of this acid by a specialized thick mucus layer which is strongly alkaline in nature and is secreted by certain mucus secreting glands of the stomach. Prostaglandins are biochemical substances that help with mucus and alkaline substance secretion.
When this protective layer is lost or the acid secretion is increased, the acid acts on the unprotected stomach and duodenum and causes the symptoms of Acidity (Acid Peptic Disease).
Causes:
The factors which cause Acidity (APD) are:
1. Infection with Helicobacter pylori, a bacterium that invades and colonizes gastric cells and hampers mucus secretion.
2. Reduction in prostaglandin secretion by drugs like Paracetamol, Aspirin, Ibuprofen ,
Mefenamic acid, Diclofenac sodium, Ketorolac, Indomethacin, grouped under non-steroidal anti-inflammatory drugs (NSAIDs).
3. Severe psychological stress (stress ulcers).
4. Severe trauma.
5. Extensive burns leading to physiological stress, where there is a special type of stomach ulcer called Curling’s ulcer.
6. Cushing’s ulcers are another type of stomach ulcers that develop due to neurological disease.
7. Local irritants like alcohol, tea, coffee, tobacco smoking and spicy food.
8. Sometimes the gastric acid finds a way up into the oesophagus (food pipe) due to various causes and leads to reflux oesophagitis (inflammation of oesophagus). Since our oesophagus is not protected against the acid of the stomach, it gets eroded and commonly presents as ‘chest burn/ heart burn’.



Complications:
1. Peptic ulcer (Gastric ulcer or Duodenal ulcer).
2. Gastric cancer.
3. Oesophageal cancer.

Investigations:
Investigations are not routinely required but in cases of severe or long standing
disease the following investigations can be done:
1. for suspected gastric or duodenal ulcer: Gastric/Duodenal endoscopy.
2. for Helicobacter pylori infection: Urea breath test, Faecal antigen test.
3. for Oesophageal symptoms: Oesophageal endoscopy, 24 hour pH monitoring.
Prevention:
Includes avoidance of triggering and precipitating factors:
1. Consumption of local irritants such as alcohol, tea, coffee, tobacco smoking and spicy food
should be avoided.
2. Prolonged use of NSAIDs hampers prostaglandin secretion and therefore these drugs should always be taken with a Proton Pump Inhibitor (mentioned below) in prone patients.
3. Irregular eating habits and late night dinner can upset the balance of the digestive system and can lead to hyperacidity.
4. Poor and irregular sleep can lead to hyperacidity.
Treatment:

1. Short term therapy:
(i) Antacids or Alginates like Aluminium hydroxide and Sodium alginate for immediate relief.
(ii) H2 receptor antagonists like Ranitidine, 50mg twice daily till symptoms subside.
(iii) Proton Pump Inhibitors like Pantoprazole 40mg or Rabeprazole 20mg twice daily till
symptoms subside.
(iv) Sucralfate is an ulcer protective gel that mechanically lines the ulcer and prevents from acid acting on it.
(v) Prostaglandin Analogues like Misoprostol to help with the mucus layer and reduce acid
secretion.
(vi) If Helicobacter pylori is suspected then start antibiotic regimen Clarithromycin 500mg twice daily along with either Amoxicillin 1gm twice daily or Metronidazole 400mg twice daily for 7 days.

2. Maintenance therapy:
(i) Proton Pump Inhibitors like Pantoprazole 40mg or Rabeprazole 20mg once daily for 1-2
months.
(ii) H2 receptor antagonists like Ranitidine 50mg twice daily for 1-2 months.
3. Surgical treatment (for non healing ulcers or recurrent disease):
(i) Partial gastrectomy which is the current surgery of choice involves the surgical removal of the ulcerated part of the stomach to permanently cure the symptoms and to prevent any future development of cancer in affected part.
(ii) Highly selective vagotomy is a surgery in which the nerves of the ulcerated area of the
stomach are destroyed whereby even on irritation, the ulcer doesn’t hurt and patient is symptom free. This surgery is not routinely practiced now and is reserved only for rare cases because of the lack of protection from a future cancer in the stomach.

Side Effects of Treatment:
1. Diarrhoea
2. Nausea, Vomiting
3. Abdominal pain
4. Headache
5. Rash
6. Dumping syndrome or Nutrient deficiency can occur after gastrectomy surgery.


Reference:http://blog.docsuggest.com/280/acidity-causes-treatment-prevention-mujtaba-hussain/