Acidity (Acid peptic disease): Gastritis, H. Pylori, Peptic ulcers, GERD and Hiatus Hernia

What is Acidity or Acid peptic disease?

Acidity is a common layperson terminology to denote any acid-related disorder. A strong acid is normally present in the stomach which helps in the digestion of food as well as preventing the entry of bacteria into the digestive system, and aids in the digestion of it. B12, calcium absorption, etc.

Strictly speaking according to the medical literature there is no such word as “acidity”. All these acid-related diseases are grouped under Acid peptic diseases, and the symptoms are called acid-related symptoms.

What are the acid-related symptoms that a person may experience?

Acid-related symptoms that a person experiences are extremely common today and affect millions of people worldwide disturbing their quality of life. These symptoms are increasingly seen today, especially in the young and productive age group. The common symptoms:

1. Burning in the upper abdomen or in the chest (heartburn)
2. Excessive gas or bloating commonly occurs after heavy meals. This symptom typically called dyspepsia may not be an acid-related symptom.
3. Burping or eructation (passage of excessive gas from the mouth)
4. Regurgitation, which means reflux of food or sour acid into the mouth after meals or lying down. Heartburn and regurgitation are symptoms typical of gastro-oesophageal reflux disease (GERD).
5. Upper abdominal pain of a burning type especially in the early hours of the morning denotes an ulcer disease.

What are the common disorders related to Acid peptic disease?

The common diseases related to acid peptic diseases are:

1. Gastritis, which means inflammation of the stomach may be due to acid, bile, B12 def., or a bacteria called Helicobacter Pylori(H. pylori).
2. Gastro-oesophageal reflux (GERD) or hiatus hernia. Hiatus Hernia is a condition where part of the stomach slides up into the chest from the abdomen, through the diaphragmatic hiatus (opening in the diaphragm) through which the esophagus enters the abdomen from the chest.

This leads to the reflux of acid, food, and gas into the esophagus. The esophagus’s inner lining (mucosa) is not used to the acid and frequently leads to inflammation (oesophagitis) or leads to erosion (superficial ulcers) or ulcers. Some such ulcers are called Baretts ulcers, which have a small propensity of turning malignant in the long run. Repeated inflammation can lead to bleeding from the ulcers or narrowing (stricture formation) which can lead to difficulty in swallowing food

3. Peptic ulcers including gastric (stomach) and duodenal ulcers related to acid attack and weak defences. These ulcers can cause abdominal pain or can lead to complications such as bleeding into the vomitus, bleeding into the stools, or rarely bursting (perforation), which demands urgent surgery. Rarely do these ulcers cause narrowing (stricture) leading to obstruction of the stomach outflow.

What are the common causes of Acid peptic disease?

Common causes of acid peptic symptoms are:-

irregular lifestyle.

excessive stress

consumption of alcohol and smoking.

Increasingly, infection due to a bacteria known as H. pylori also is an important cause of Gastritis today. H. pylori infection generally occurs from infected food or water.

Overweight and obesity have a direct correlation with GERD and hiatus hernia. This is related to increased fat deposition around the GE junction which makes it lax and increased intra-abdominal pressure due to abdominal wall fat.

Increased intake of fatty food also leads to more laxity of the LES leading to more amount of reflux.

Consumption of excessive painkillers such as NSAIDs and prolonged use of aspirin is also an important cause of gastritis and peptic ulcers.

How can we detect acid-peptic diseases?

The best way these acid peptic diseases can be diagnosed is by:-

1. UGI Endoscopy, also called Gastroscopy.
2. Special tests such as Oesophageal manometry which measures LES pressures and esophagus motility as well as 24-hour phmetry which measures oesophageal acid exposure over 24 hours needed in a few patients of GERD and hiatus hernia when their endoscopy is negative or they are planned for laparoscopic antireflux surgery.
3. H. pylori can be detected by a urea breath test, endoscopic biopsy, blood antibodies, or stool antigen testing.

How are acid peptic diseases treated?

1. Gastritis is treated by avoiding offending agents such as alcohol, smoking, stress, or NSAIDs. Generally, 2-4 weeks of acid suppression with the use of proton pump inhibitors (PPI) are needed to heal gastritis.
2. If Helicobacter pylori is responsible for gastritis in the form of positive testing, eradication is done with the help of the triple regimen of double dose ppi and two other antibiotics either Clarithromycin, Tinidazole or Amoxycillin for 10-15 days.
3. Uncomplicated Peptic ulcers are generally treated with 4-6 weeks of PPI therapy. This would cure almost 90-95 % of all ulcers. Eradication of H. Pylori is important to reduce the recurrence of ulcers. The offending agent in the form of alcohol, smoking, stress, irregular lifestyle, or NSAIDs must be avoided to reduce the recurrence of peptic ulcers.
4. Dietary and Lifestyle modifications are very important for long-term control of GERD. These include avoiding spicy and fatty food, weight reduction, taking 3-4 small meals, avoiding heavy meals, avoiding lying down for at least 2-3 hours after a meal, avoiding prolonged fasting, and managing stress by use of yoga, meditation, and pranayama. Regular exercises are also an important part of lifestyle modification to control symptoms of GERD.

How can we prevent acid-peptic diseases?

Acid peptic diseases can be prevented by pursuing a healthy lifestyle and avoiding offending agents.

1. A healthy diet includes regularity in diet, pursuing lots of vegetables and fruits in the diet, avoiding oily, fatty, and spicy food, avoiding heavy meals, and avoiding lying down for at least 2 hours after meals.
2. Regular exercises in the form of walking, cycling, swimming, or other aerobic exercises for at least 45 min to 1 hour a day keep a person fit and prevent acid peptic diseases.
3. Regular practice of Yoga, meditation, and pranayama have also been shown to prevent acid peptic diseases.
4. Avoiding smoking, alcohol, and excess NSAIDs, and control of stress go a long way to prevent such severe symptoms.

Author :- Dr Sanjiv Haribhakti

M.Ch. GI Surgeon of Western India

Kaizen Hospital