Severe acidity and reflux are health problems that spoil the patient's simplest details of his day, from enjoying food to sleeping comfortably.

What is severe acidity and what is reflux?

Severe acidity is a condition that occurs when the secretion of stomach acids increases and rises into the esophagus, causing a burning or pain in the chest, often known as “heartburn.” As for gastroesophageal reflux, it is a more advanced stage of acidity and is considered a chronic disorder. It occurs when acid repeatedly returns from the stomach to the esophagus, which may lead to inflammation and irritation of the lining of the esophagus.

In severe cases, the affected person may feel a bitter or sour taste in the throat, along with a feeling of pressure in the chest or indigestion, especially after eating or when lying down.

Symptoms accompanying it include:

• Frequent heartburn in the chest.
• Sour taste in the mouth.
• Difficulty or pain while swallowing.
• Dry or chronic cough.
• Hoarseness or frequent sore throat.
• A feeling of something stuck in the throat.

What is the treatment for severe acidity and reflux?

Treatment for severe acidity and reflux depends on the severity of the condition and its causes, and includes three stages, which are lifestyle changes, the use of medications, and in some cases medical or surgical intervention.

First: lifestyle changes

It is the first and important step in treating severe acidity and reflux, and it includes:

• Avoid foods that cause aciditySuch as: fatty foods, citrus fruits, chocolate, caffeine, mint, and soft drinks.
• Eat small, scattered mealsInstead of large meals.
• Do not lie down immediately after eatingAnd wait for at least two hours.
• Elevate the head while sleeping To reduce acid reflux.
• Lose weight If there is weight gain, intra-abdominal pressure increases.
• Quit smokingBecause it weakens the lower esophageal sphincter.

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Medications used to reduce stomach acid secretion or relieve symptoms include:

• Proton pump inhibitors (PPls).
• And histamine 2 receptor antagonists. 
• Antacids. 
• Medicines that enhance digestive motility.

In cases where infection with stomach bacteria is proven, treatment includes a drug plan known as triple therapy, which consists of: 

• Two antibiotics (such as clarithromycin, amoxicillin, or metronidazole).
• Proton pump inhibitor.
• If resistance to antibiotics is present, quadruple therapy is used, adding bismuth to the regimen.

Third: Medical or surgical intervention

If the condition does not improve with medications and lifestyle changes, or if there are complications such as ulcers, strictures, or changes in the lining of the esophagus (Barrett's esophagus), surgical intervention may be recommended, most notably:

• Nissen valve stabilization procedure (Nissen fundoplication): It is the most common operation, in which part of the stomach floor is wrapped around the lower esophagus, to strengthen the valve and prevent reflux.

• Modern technologies such as LINX device: It is a magnetic ring implanted around the esophagus, which allows food to pass but prevents acid reflux. 

Surgery is usually performed laparoscopically and is considered very effective in reducing symptoms and improving quality of life when conservative treatment fails.

Fourth: Regular medical follow-up

Follow-up with a gastroenterologist is important, especially if symptoms are persistent or severe, or if other worrying symptoms appear, such as difficulty swallowing, unexplained weight loss, frequent or bloody vomiting, or persistent chest pain that does not respond to treatment.

The doctor may ask you to perform a gastroscopy or acidity measurement, to evaluate the severity of reflux and determine the appropriate line of treatment.

Diagnosis and treatment of severe acidity and reflux

Diagnosis and treatment of severe acidity and reflux usually begins by evaluating the symptoms described by the patient, such as a burning sensation in the chest, reflux of acidic food or liquids into the mouth, and sometimes difficulty swallowing.

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The doctor listens to the patient's complaint and details of the symptoms, such as when they started, when they occur, and how frequently they occur, and looks for signs indicating the presence of complications or symptoms associated with acidity, which helps the doctor draw an initial picture of the condition.

• Diagnosis with treatment

In some cases, if symptoms are clear, and there are no other signs, the doctor may order a trial of drug therapy, such as proton pump inhibitors, for two to four weeks. If the symptoms disappear or improve significantly, this is an indirect confirmation of the diagnosis.

• Gastroscopy

Upper endoscopy is one of the most accurate examinations.

• Verify the presence of infections or ulcers in the esophagus.
• Evaluate the severity of acid-induced inflammation.
• Discover conditions such as Barrett's esophagus, which are changes in the lining of the esophagus that may be associated with an increased risk of cancer.

• Measurement of pH in the esophagus

It is an advanced test to measure the amount and duration of acid reflux into the esophagus within 24 hours.

• Cases that do not respond to treatment despite clear symptoms.
• Evaluate the relationship between symptoms and acid reflux.
• Preoperative diagnosis.

• Measurement of esophageal motility

Doctors use this examination to measure the strength of the esophageal muscles and the efficiency of the valve separating the esophagus from the stomach.

• Barium swallowing imaging

This examination is sometimes ordered to see the esophagus as it functions during swallowing.

• Whether there is acid reflux.
• Presence of narrowing of the esophagus.
• Abnormalities in the shape of the stomach or hiatal hernia.

• Laboratory analyses

When diagnosing cases of chronic acidity that do not respond to traditional treatment, it is recommended to perform a test to detect stomach bacteria, which is done in several ways, including:

• Stool examination to detect stomach bacteria antigens (H. Pylori Antigen test).
• Blood analysis to detect antibodies to stomach bacteria.
• Urea breath analysis.

At Al Mousa Specialist Hospital, severe acidity is diagnosed using gastroscopy and accurate analyzes to determine the cause and severity of the symptoms.

What medications are used to treat acidity and reflux?

The medications used to treat severe acidity and gastroesophageal reflux aim to reduce acid production, relieve symptoms, and help heal the esophageal lining. The most important treatment medications include:

• Proton pump inhibitors (PPls): Such as omeprazole, esomeprazole, and lansoprazole.

• H2 blockers: Like famotidine, it helps reduce acid secretion but is less effective than PPls.

• Antacids: Such as aluminum hydroxide, magnesium hydroxide, or calcium carbonate, are used for quick, temporary relief when symptoms occur.

• Drugs that stimulate gastrointestinal motility (Prokinetics): Such as domperidone or metoclopramide, are sometimes used to help the stomach empty faster and reduce reflux.

• Protective medications for the stomach lining: Such as sucralfate (protects the lining of the stomach and esophagus and helps heal ulcers),

• If it is Stomach bacteria Because of acidity, a special treatment is added to it that includes two antibiotics in addition to a proton pump inhibitor for 10-14 days. Bismuth is sometimes used with treatments for stomach bacteria and has anti-inflammatory properties.

Book your consultation now at مركز أمراض الجهاز الهضمي At Al Mousa Specialist Hospital.

Complications of acidity and reflux

If the patient is left untreated, severe acidity and reflux can be dangerous. Over time, the constant reflux of stomach acids can cause damage to the lining of the esophagus and affect the patient’s quality of life. The most important of these complications are:

• Esophagitis

It occurs as a result of repeated and continuous irritation of the esophageal lining by stomach acids, which leads to:

• Pain in the chest or behind the sternum.
• Difficulty swallowing.
• Severe burning sensation.
• Sometimes mild bleeding (appears in vomit or stool).

• Esophageal ulcers

They occur due to chronic erosion of the lining of the esophagus, leading to:

• Sharp pain while swallowing.
• Bleeding from the esophagus.
• Anemia due to chronic bleeding.
• Bloody taste in the mouth or vomiting blood.

• Esophageal stricture 

Over time, chronic inflammation and resulting scarring cause:

• Esophageal narrowing.
• Difficulty swallowing (especially solid foods).
• Sensation that food is standing in the throat.
• The need to expand the esophagus using an endoscope.

• Barrett's Esophagus

It is a condition in which the tissue of the esophagus turns into a different type of cell due to chronic irritation from stomach acids. It is considered:

• Pre-cancer condition.
• Increases the risk of esophageal cancer (especially if acidity persists without treatment).
• It is diagnosed and detected by gastroscopy and a biopsy for diagnosis.

• Gastrointestinal bleeding

When the lining of the esophagus is severely eroded, bleeding ulcers may appear, which can be seen with an endoscope. It is noted that:

• Vomiting that is bloody or looks like coffee grounds (evidence of upper gastrointestinal bleeding).
• Dark black stools.
• A drop in blood pressure if the bleeding is severe.
• Dizziness or fatigue due to anemia.

• Esophageal adenocarcinoma

It is one of the most serious complications of untreated severe acidity and long-term reflux. However, it is relatively rare. The risk of developing it increases in cases of “Barrett’s esophagus.” It is diagnosed by gastroscopy and taking a sample and analyzing it.

• Respiratory and chest problems

Due to acid reflux into the respiratory tract or throat, symptoms may include such as:

• Chronic cough.
• Asthma or worsening of asthma symptoms.
• Recurring lung infections due to acid inhalation.
• Hoarseness and chronic laryngitis.

• Impact on quality of life and sleep

Nighttime insomnia due to acid reflux when lying down, a feeling of constant fatigue and mood swings.

Frequently asked questions

How can I get rid of acidity immediately?

This can be done in several ways, including:

• Drink lukewarm water.
• Chew sugar-free gum.
• A cup of cold milk or yogurt.
• Eat a ripe banana.
• A spoon of honey.
• Sodium bicarbonate.
• Take antacid medication for immediate relief.

What is the best solution for heartburn and acidity?

The best treatment for severe acidity and reflux is a combination of drug therapy and lifestyle modification.

What do I drink for acidity?

Drinks that soothe acidity include lukewarm water, free or low-fat milk, water with a teaspoon of honey, water with fennel or warm ginger in moderate quantities, and a warm chamomile drink.

In conclusion, the problem of acidity is a common problem, but there are many solutions to treat severe acidity and reflux, whether by adhering to a healthy lifestyle and taking effective medications when needed to relieve symptoms. If symptoms persist for a chronic period and do not respond to medication, do not hesitate to consult a doctor, to ensure accurate diagnosis and optimal treatment.

Sources

Mayoclinic- GERD