The stomach may seem like an unremarkable organ but the way in which it produces and withstands the strong gastric acid is unique in the human body. However, there are times when the stomach acid can become a problem to the stomach itself or parts of the gut lying next to the stomach. This can cause a host of symptoms which we associate with acidity and may refer to as an ‘acidic stomach’.
What is an acidic stomach?
An acidic stomach may refer to several upper gastrointestinal conditions associated with increased stomach acid or where the stomach acid injures the lining of the gut. This includes GERD (acid reflux), gastritis, duodenitis and peptic ulcer disease. Many of the symptoms overlap and this may sometimes be referred to as acid indigestion. Food and beverages may aggravate the symptoms but are usually not the cause.
Most people who suffer with these conditions will also report an improvement of symptoms with the use of antacids or acid-suppressing drugs. Changes in diet and lifestyle can also help ease symptoms and is an important part of management. An acidic stomach may not seem like a serious condition but these symptoms can sometimes be caused by serious diseases.
Causes of Acidic Stomach
The stomach produces a corrosive acid and powerful digestive enzymes to chemically breakdown food. The acid and enzymes could also digest stomach tissue but there are mechanisms to prevent this from happening. The stomach prodces large amounts of mucus which form a barrier along the stomach surface. It prevents the acid and enzymes from making contact with the stomach wall.
The neighboring duodenum (small intestine) and esophagus (food pipe) cannot handle this acid and have their own mechanisms to neutralize it. The duodenum is flooded with water and alkaline bile to dilute and neutralize the acid when it enters. The esophagus is usually spared from the stomach acid by a one-way valve known as the lower esophageal sphincter (LES). However, when acid does enter the esophagus, mucus and saliva can help to neutralize it.
Failure of the Mucus Barrier
When the mucus barrier malfunctions in a certain area, the acid then makes contact with the stomach wall. It irritates, inflames and damages the stomach tissue. This is most commonly caused by the overuse of NSAIDs (non-steroidal anti-inflammatory drugs) and by H.pylori bacteria that damages the stomach tissue in a certain area. It leads to inflammation of the stomach wall (gastritis) and may also result in open sores (ulcers).
The lower esophageal sphincter (LES) may become weakened, either temporarily or permnently. This allows stomach acid to flow backwards into the esophagus (food pipe). The acid the irritates the esophagus that cannot cope with it. This condition is known as acid reflux or gastroesophageal reflux disease (GERD). Overeating, alcohol and spicy foods may worsen it but are not the cause of GERD.
Excessive Stomach Acid
Stomach acid production can temporarily increase beyond the normal range for several different reasons and in a number of different conditions. However, sustained stomach acid production is usually due to a condition known as Zollinger-Ellison syndrome. The quantity of stomach acid may be too large for the stomach and duodenum to manage and this may also irritate the esophagus.
Symptoms of Acidic Stomach
The term acidic stomach refers to symptoms associated with disturbances in stomach acid production and the parts of the gut exposed to it. Gastritis, peptic ulcer disease and gastroesophageal reflux disease (GERD) are common upper gastrointestinal conditions around the world. Zollinger-Ellison syndrome is rare and therefore not discussed further. The signs and symptoms that may occur include:
- Heartburn (specifically GERD)
- Upper left to upper middle abdominal pain (specifically gastritis and peptic ulcer disease)
- Nausea and sometimes vomiting
- Changes in appetite
- Excessive belching
- Blood in vomit or stool (peptic ulcers)
- Sensation of fullness (gastritis and peptic ulcers)
Certain foods, beverages, lifestyle factors like smoking and psychological states like anxiety can trigger or aggravate these symptoms. It is important to note that the lack of symptoms does not mean that the conditions in question have resolved. There may be periodic improvement of the condition and sometimes a person can be asymptomatic despite having a problem, for example in the case of silent acid reflux.
Read more on acidic burps.
Treatment of Acidic Stomach
The treatment for GERD, gastritis and peptic ulcer disease are similar to some extent. Symptomatic relief involves reducing stomach acid production or neutralizing the excess acid. Then the specific underlying cause of each of these conditions has to be treated in order to resolve the condition and prevent a recurrence.
- Antacids neutralize stomach acid temporarily.
- Acid-suppressing drugs like proton pump inhibitors (PPIs) and histamine (H2) blockers reduce stomach acid production.
- GERD usually requires surgery when chronic – Nissen fundoplication or insertion of a Linx device.
- Gastritis may also require antibiotics if it is caused by H.pylori infection.
- Peptic ulcer disease may also require antibiotics and a bismuth compound.
Although antacids and some acid-suppressing drugs are available over-the-counter, these drugs should not be used for long periods of time without medical attention. It only provides temporary symptomatic relief and can lead to a host of side effects. A medical professional will need to assess the underlying cause. This may require diagnostic investigations like a barium x-ray and upper GI endoscopy. Thereafter the appropriate treatment will be prescribed.
Diet and Lifestyle
The following dietary and lifestyle changes may help control symptoms but medical treatment is still necessary.
- Avoid overeating. Rather eat many small meals throughout the day.
- Alcohol consumption should be minimized and cigarette smoking must be discontinued.
- Do not eat at least 2 to 3 hours before bedtime. Lying down after meals, even if not sleeping, can worsen the symptoms.
- Sleep with the head section of the bed slightly elevated. This can be done by raising the head end with bricks or using a wedge to keep the head and chest elevated.
- Mild exercise and other physical activity after a meal can help but overexertion can worsen symptoms.
- Take note of trigger foods and avoid these. Spicy foods, chocolates and caffeinated beverages are some of the more common dietary triggers.