Stomach acid and acid reflux

In this article we'll take a look at stomach acid, its role in digestion and some common problems involving stomach acid. We'll also look at ways in which you can prevent acid reflux with lifestyle and dietary changes. Then finally, we briefly examine some of the common treatments for the condition.

The digestion process from mouth to stomach

As you will see, stomach acid becomes an essential part of the digestive process. But first, the process begins in your mouth.

Digestion in the mouth:

• Your teeth chew your food and break it into smaller pieces.  It is then swallowed for further digestion
• Saliva in your mouth helps to soften the food. It also contains an enzyme that breaks down starch in your food into sugar
• Food then passes down the food pipe (oesophagus) and a ring of muscle (sphincter) opens to allow the food to pass down into your stomach. Once the food has passed through, the sphincter closes again to keep the food in your stomach

Digestion in the stomach:

You can think of your stomach just like a big bag that contains stomach acid (hydrochloric acid). This acid is essential for 3 main reasons:

1. It helps to kill bacteria that may be present in the food we eat
2. It helps to break down your food even further
3. It creates favourable conditions for the enzyme pepsin to work. This enzyme helps break down protein in your food

The movement, or churning, of the stomach together with the action of stomach acid and enzymes continues breaking the food down into a semi- liquid form known as chyme. Various nutrients can then be extracted, or absorbed, once it passes on its journey into your intestines.

So, stomach acid is a key part of this digestion process. But now we're going to look at what unwanted effects stomach acid can have if it doesn't stay in place.

Acid Reflux – Symptoms and Causes

You may hear the term acid reflux linked with gastro-oesophageal reflux disease or GORD. But GORD is a general term that includes various symptoms associated with the upper part of the digestive tract (the mouth, oesophagus and stomach) and these are usually caused by acid reflux.

In some people acid reflux results in the symptoms of heartburn. While in others, inflammation of the oesophagus (oesophagitis) can occur. Pain and/or difficulty when swallowing are also symptoms. An acidic taste in the back of the mouth may be experienced too.¹ It can vary from person to person and any combination of one or more of these symptoms is possible. But now we'll concentrate on the process involved in acid reflux.

How does acid reflux happen?

Acid reflux happens when acid passes up (refluxes) out of the stomach and into the food pipe (oesophagus). This occurs through either having a weakened sphincter failing to keep stomach acid fully in place where it belongs, too much stomach acid, or a very full stomach. Any or all of these can increase the chances of acid reflux occurring. Two of the problems that can result from acid reflux are heartburn and oesophagitis:

Heartburn

Heartburn is a symptom of acid reflux that can result if acid refluxes up into the oesophagus. It usually involves a hot, burning pain in the chest and throat area. Sufferers may also have a tight feeling in the chest and sometimes an acidic taste in the mouth. This may also be associated with a feeling of sickness.

The term "heartburn" has nothing to do with an effect on your heart. It's simply that the area where pain is felt, is generally in the chest area near the heart. Acid in the oesophagus can cause pain because, unlike the lining of your stomach, the lining of the oesophagus is not designed to withstand the acid. So pain can result if stomach acid comes into contact with it.

The amount of acid and length of time it is in contact with the lining of the oesophagus, are both factors affecting whether you will feel the symptoms.

Oesophagitis

Oesophagitis simply means inflammation of the oesophagus or food pipe. It may not always occur if stomach acid refluxes. But if it does, the tissue that lines the oesophagus becomes inflamed and painful, for the reason given above.

Are any tests necessary for acid reflux?

You may be familiar with the symptoms of acid reflux already, but if you are in any doubt, you should consider checking with your doctor.

Doctors are familiar with acid reflux and its symptoms and are usually able to diagnose the problem easily. So tests are not routinely needed. But if your doctor believes there may be a more severe problem, you could be referred to hospital for tests, such as a gastroscopy.

You can help prevent acid reflux in two main ways:

1. Make lifestyle changes

• Stop smoking - or at least cut down. The chemicals found in cigarette smoke can cause the sphincter at the bottom of your oesophagus to relax. This can make it easier for stomach acid to reflux²
• Reduce Stress - whilst there is no direct evidence that stress causes acid reflux, it is known to be a potential trigger. So by identifying what causes you stress, and then trying to reduce it, may help improve your condition.
• Avoid wearing tight clothing - tight waistbands can put unwanted, extra pressure on your stomach and abdomen, which can contribute to causing reflux
• Watch your weight - carrying a little too much weight can also put added pressure on the stomach and again may help to cause reflux.

2. Be careful what you eat

Many foods are known to be "triggers" of acid reflux, so try to avoid them if you can. If you're unsure what your triggers may be, then keeping a food diary could help you. Typically, common triggers include:

• Spicy foods, such as curries
• Onions, garlic, tomatoes, peppers
• Citrus fruits
• Fatty foods

Eating big meals can also be a trigger. If you stomach is too full, the risk of reflux may be increased simply due to the volume of food pushing up against the sphincter. Smaller meals, eaten more often, can help you avoid this

Treatments that help prevent or treat acid reflux

H2-antagonists and PPIs

The two main preventative treatments are H2-antagoninsts (also called H2-receptor antagonists or H2- blockers) and PPIs, or proton pump inhibitors.  These treatments need to be taken in tablet form and have to enter your bloodstream in order to exert their stomach acid reducing effects. Some types are available over the counter, but quite often doctors will prescribe them if symptoms of acid reflux are severe enough and/or persistent.

Antacids

Antacids may also be used to treat acid reflux, but tend to be for milder symptoms. They contain acid neutralising substances such as calcium carbonate, magnesium carbonate or aluminium hydroxide.

Alginates such as Gaviscon Extra

Gaviscon Extra utilises two processes to treat your acid reflux:

• Firstly, one of the ingredients in Gaviscon Extra is called sodium alginate. When this comes in contact with the acid in your stomach, a thick layer (often referred to as a "raft") begins to form. This creates a strong physical barrier to help to keep acid in the stomach, where it belongs - not in the oesophagus where it can cause pain
• Secondly, Gaviscon Extra also contains calcium carbonate and sodium bicarbonate, which work quickly to neutralise stomach acid

A helpful video of how Gaviscon Extra works to bring effective relief of acid reflux can be seen if you click here.

Gaviscon Extra can be bought over-the-counter.  It can also be taken by pregnant women. It doesn't need to enter the blood stream to provide effective relief.

Like antacids, Gaviscon Extra can be used to treat the symptoms of acid reflux as soon as they start. But Gaviscon Extra offers a longer-lasting effect. In fact, its effect lasts up to twice as long as antacids. 

Stomach acid - friend and foe

To conclude, we've seen that stomach acid is essential because it enables your stomach to play its part in the digestive process and to do its job properly. But the key is to try to do whatever you can to help stomach acid stay there where it belongs, and not in the oesophagus.

If you are ever in any doubt about your symptoms, always consult a doctor or other healthcare professional for advice.

 

All information presented is not meant to diagnose or prescribe. Gaviscon Extra Oral Suspension, and Gaviscon Extra Chewable Tablets contain Sodium Alginate, Sodium Hydrogen Carbonate, Calcium Carbonate for Heartburn & Indigestion. Always read the label. If symptoms are severe or prolonged you should consult a doctor or pharmacist.

 

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