Hyperacidity refers to abnormally high volumes of acid or very low pH (more acidic). Since the stomach produces acid, hyperacidity usually refers to excessive stomach acid or abnormally acidic stomach acid. The quantity of the acid in the stomach is carefully regulated as is the level of acidity (pH). It tends to increase during and immediately after eating as this is when the acid is most needed.
Another term for this excessive stomach acid is hyperchlorhydria. Although the stomach has mechanisms to withstand the acid, it can sometimes not cope when the acid is excessive or very acidic. The surrounding parts of the digestive tract, like the esophagus (food pipe) and duodenum (small intestine), may also be affected by the excessive stomach acid and very acidic digestive juices from the stomach.
The effect of the excessive acid in the stomach and surrounding parts of the digestive tract causes a host of signs and symptoms. This includes a burning pain in the upper left abdomen, heartburn, alterations in appetite and nausea. There are several treatments for hyperacidity. It can involve neutralizing the acid or reducing stomach acid production.
Causes of Excess Stomach Acid
The production of hydrochloric acid is carefully regulated in the stomach. This gastric acid is required for chemical digestion and acid production increases during a meal. The acid mixes with the food and fluid in the stomach. Strong muscle contractions in the stomach are responsible for this mixing and crushes hard and large food particles.
A layer of mucus protects the stomach wall from the corrosive acid and power digestive enzymes within the stomach. Partially digested food mixed with digestive enzymes and hydrochloric acid then pass out into the duodenum (small intestine). Here the secretions from the bile and pancreas neutralize the acid before it damages the small intestine tissue.
However, if the acid is excessive or if the pH is very low (high acidity) then the stomach and duodenum mechanisms may not be sufficient to prevent tissue damage. If this acid and enzyme flows backwards, it will enter the esophagus and cause extensive tissue damage. Although less common, excessive stomach acid may pass to the lower parts of the gut where it can also cause irritation and injury.
Reasons for Increased Stomach Acid
Although stomach acid production is carefully regulated, it can be influenced by a host of factors. This includes dietary and lifestyle factors, as well as certain medication and illicit substances. Several diseases can also result in increased stomach acid.
- Caffeinated beverages like tea or coffee.
- Nicotine including tobacco products and nicotine replacement products.
- Excessive gum chewing.
- Certain foods, particular spicy meals.
- Alcoholic beverages.
- Overeating and fasting.
- Certain medication, prescription and over-the-counter.
- Psychological stress.
- Infection of the stomach, like H.pylori, which also causes gastritis and peptic ulcers.
- Zollinger-Ellison syndrome where a tumor causes increased acid secretion.
- Any diseases that increases activity of acid-producing glands in the stomach, the nerves or hormones that control these glands.
Sometimes the acid may be of normal volume and pH yet can pose a problem if the various compensatory mechanisms are affected. For example, certain NSAIDs (drugs) block the mucus barrier that lines the stomach. This allows the acid to make contact with the stomach tissue. It causes chemical injury and damage to the tissue.
Similarly if the stomach enters parts of the gut which cannot deal with the acid, it can be a problem. For example, in acid reflux the stomach acid and enzymes flow backwards into the esophagus. Excess saliva may be produced and swallowed to neutralize this acid and push it back into the stomach. The esophagus cannot withstand the presence of this acid.
Symptoms of Excess Stomach Acid
The effects of hyperacidity is most evident in the stomach and surrounding regions, the esophagus that precedes the stomach and the duodenum (small intestine) that follows. The main conditions that arise with this excess stomach acid is gastroesophageal reflux disease (GERD) and esophagitis which affects the esophagus, gastritis which affects the stomach and peptic ulcers in the stomach and duodenum (small intestine).
Common symptoms in all of these conditions include nausea, changes in appetite, bloating, and sometimes vomiting. Specific symptoms may overlap. For example, gastritis and peptic ulcers are similar in presentation. Heartburn (burning chest pain) is more common in GERD. A burning pain in the upper middle abdomen is more likely with gastritis and peptic ulcers.
Diet and Lifestyle Remedies
Dietary management for regulating stomach acid production may only have a moderate effect. However, diet may assist with reducing the symptoms and preventing the onset of conditions attributed to excess stomach acid. Lifestyle changes may also be useful in the overall conservative management of conditions like gastritis, peptic ulcer and acid reflux.
- Avoid trigger foods and irritants – alcohol, caffeinated drinks, carbonated beverages, preserved and spicy foods are known irritants in most cases.
- Fatty foods are known to increase gastric acid secretion and should therefore be limited.
- ‘Gassy foods’ may cause regurgitation of the acidic stomach contents during burping.
- Gum, tobacco and areca nut/betel leaf chewing should be avoided altogether.
- Eat small meals throughout the day rather than a single large meal.
- Avoid lying flat or sleeping after a meal.
- Moderate activity after eating may help reduce the symptoms associated with excess stomach acid but exercise and strenuous activity should be avoided immediately after a meal.
- Cigarette smoking should be stopped as it increases gastric acid secretion.
Read more on gastritis diet.
Treatment of Excess Stomach Acid
Excess stomach acid may resolve on its own but can be managed with diet, lifestyle and medication. The treatment of excess stomach acid usually involves antacids at the outset. These substances neutralize the stomach acid but offer short term relief. It is effective for acute episodes. However, other drugs may also be necessary
Proton pump inhibitors (PPIs) are used for severe and ongoing cases. Along with H2-blockers, PPIs are known as acid-suppressing drugs since these drugs reduce gastric acid secretion. Sometimes drugs that speed up movement through the stomach are necessary. Known as prokinetic drugs, it hastens the emptying of the stomach.
While these drugs may treat the acidity, it does not always address the underlying cause. For example, H.pylori infection requires antibiotic eradication therapy. Severe gastroesophageal reflux disease (GERD) may require surgical intervention like a procedure known as Nissen fundoplication. Complications of these conditions may also require surgery.