Lifestyle, Preventative Health and Medications

Why do we have acid in our stomach?

We need acid to aid in the digestion of food. The stomach produces acid from the very first day of life. Acid production increases gradually as one matures into adulthood. Acid secretion remains almost the same throughout adult life unless affected by a disease, for example, with Helicobacter Pylori infection.

Why do we need acid?  

Acid has multiple functions. It aids the digestion of proteins. It facilitates absorption of iron, vitamin B12, and some medicines like thyroxine and calcium. It places a crucial role in preventing intestinal infection and intestinal bacterial overgrowth.

How does the stomach protect itself from acid? 

Though gastric acid has useful functions, it can affect the integrity of the stomach lining. The Stomach secretes protective substances like mucin and bicarbonates which help protect against deleterious effects of acid. A delicate balance needs to be maintained to reap the benefits of acid without the untoward effects. Complex neural and hormonal pathways are involved to maintain this balance in a healthy individual.

What are the effects of excessive acid secretion?  

Excessive acid can cause gastric and duodenal ulceration which may result in life-threatening acute blood loss. Acid reflux in the “food pipe “(oesophagus) causes heartburn, esophagitis (inflammation of the oesophagus) and a potentially pre-cancerous condition, Barrett’s oesophagus. Over acid production may have a role in functional dyspepsia. Patient with functional dyspepsia complain of abdominal bloating, upper abdominal pain, nausea, vomiting, feeling full quickly after a meal (early satiation).

What causes excessive acid secretion?   

In a healthy individual, the thought, smell, sight and taste of food increases acid production in the stomach in preparation for a meal.

Chronic infection by a bacterium called Helicobacter Pylori can increase acid secretion to harmful levels (depending on the site of infection). Some medicine like painkillers, steroids can enhance the harmful effects of acid in the stomach.

Which medicines can help to reduce Acid Suppression?  

To help control the symptoms of dyspepsia and prevent serious effects of excessive acid secretion, different medications can be used. PPIs (Proton Pump Inhibitors) are the most commonly used. They are called PPIs because they block “Proton Pumps” in the stomach cells that make acid.

There are a few types of PPIs, for example, omeprazole, lansoprazole, rabeprazole, pantoprazole, and esomeprazole. They work better if taken 30 minutes to one hour before breakfast. An additional dose can be taken before dinner if advised by your physician. Usually, PPIs are well absorbed by the body and may provide quick relief of symptoms for certain conditions, such as acid reflux. For other conditions like gastric ulcer, your physician may prescribe PPIs for a longer duration. Your physician may also prescribe PPIs to reduce the risk of ulcer formation when taking concomitant medications such as aspirin or clopidogrel.

Histamine-2 (H2) blockers are another group of medications that suppress acid. Examples of which are ranitidine, famotidine, and cimetidine. In general, PPI is used as the first line as they have stronger acid suppression than H2 blockers. Your physician may use H2 blockers when you are allergic to PPIs.

Antacids (i.e. MMT) also helps to reduce symptoms of excessive acid secretion. They contain alkaline ions that chemically neutralize acid in the stomach. They contain ingredients such as aluminium, calcium or magnesium which acts as alkalis to counteract stomach acid. You should not take Antacid and other medication including PPIs at a similar time. Antacids can affect the absorption of other medications.

Which agent is better?

Proton pump inhibitors have stronger acid suppression abilities than H2 blockers. Though Antacids may reduce symptoms, they are not very effective for acid suppression. A number of medical studies have compared the various proton pump inhibitors to one another. The differences have been small and of uncertain clinical importance. Your physician may choose a specific agent and change it later depending on your specific clinical condition.

Are there any side effects of PPIs? 

Though PPIs are a generally safe group of medications, prolonged use can increase the risk of conditions such as Clostridium difficile diarrhoea, intestinal bacterial overgrowth, osteoporosis.

Conclusion

Whilst gastric acid plays a key role in the digestion of food, acid overproduction can lead to troublesome symptoms such as heartburn and dyspepsia and in some cases life-threatening conditions such as gastrointestinal bleeding from peptic ulcer disease.

Your physician may prescribe a short course of PPIs for symptoms such as heartburn and dyspepsia and recommend for an “as needed” strategy thereafter. In patients who are taking medications such as aspirin or clopidogrel, long-term acid suppression with PPIs have been shown to reduce the risk of ulcer formation.

Do I need to go for this test if I do not have any bowel symptoms? 

Like optical colonoscopy, CT colonography is recommended for everyone above the age of 50 who have a stool FIT positive as colon cancer may not result in any symptoms in the early stages.

What are the risks? 

CT colonography is considered a very safe procedure. Minor side effects include abdominal bloatedness or dizziness. Serious side effects (which are extremely rare) include damage to the large bowel wall (the chance of this happening in CT colonography is much lower than in optical colonoscopy) and severe allergic reactions to dye injected into the blood vessels during the CT scan.