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Dr. Manik G. Hiranandani
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Peptic Ulcers, Heart burn and hyperacidity

When I was 16 years old I suffered from Juvenile Rheumatoid arthritis. To control the pain of the arthritis I used to take 6-7 aspirins every 3 hours, making a total of 50-60 aspirins every day for about 18 months. One of the side effects of aspirin in such large doses was gastric irritation. I used to feel a burning sensation in the centre of my chest, a sour taste in my mouth with the bitter taste of the aspirin and a pain in my upper abdomen. Taking an antacid gave me relief for a hour or two, but invariably the pain returned.

I soon learnt that taking the aspirin after food caused less discomfort than taking it on an empty stomach. Having it with oily food prolonged the discomfort while taking it with a fruit like a banana eased the pain. Of course it was a great problem to find something to eat every 3 hours around the clock!

This was my introduction to Gastric Reflux Now called GERD or Gastro esophageal reflux disease! This condition affects hundreds of millions of people worldwide and causes a lot of avoidable suffering.

Functions of the Stomach

The main function of the stomach is to store and mix the food with gastric juices, and release it slowly into the small intestine where it can be digested and absorbed into the blood stream. It secretes hydrochloric acid, pepsin, mucous and hormones to start and regulate the process of digestion. The hydrochloric acid kills bacteria, fungus, parasites and viruses and makes the stomach contents acid  starting the breakdown of protein so it can be digested. It secretes pepsin, an enzyme which starts the breakdown of foods high in protein, in the stomach. It also secretes hormones which regulate the digestion and the blood sugar.

This mixture of food, acid and enzymes is kept in the stomach by valves at the top and bottom of the stomach. The valve at the upper end of the stomach is called the gastro esophageal valve or cardiac spincter, and it prevents acid reflux. The function of this valve is supplemented by the muscles of the diaphragm which surround the valve, which contract to prevent the reflux of food into the esophagus. The valve at the lower end of the stomach is called the gastro duodenal valve or pyloric sphicter. This valve relaxes at regular intervals, to slowly release the gastric fluid mixed with food into the duodenum for further digestion and absorption in the small intestine. The stomach and duodenum are protected from digesting itself by a thick coat of mucous which protects it from the acid and pepsin.

This protective lining of mucous can be damaged by alcohol, Nicotine from cigarettes, stress, pain killers, all anti-inflamatory drugs like aspirin, Ibuprofen, Diclofenac, Naprosyn and steroids. These substances also increase gastric acid secretion. The gastric acid can penetrate through the damaged mucous layer to attack the stomach's lining and cause peptic ulcers. Food allergies, especially milk allergy increase gastric acid secretion and also damage the stomach lining. This damaged lining is damaged further when there is an excessive accumulation of acid in the stomach. Aluminium also damages this protective lining of mucous. Food cooked in aluminium utensils, aluminium foil and aluminium containing antacids are a common cause for peptic ulcers.

Fats are digested slowly and cause slow emptying of the stomach. The combination of high protein and high fat foods like fried meats or nuts cause increased gastric acid secretion accompanied by slow emptying of acid from the stomach. This acid stays in contact with the gastric lining and if it has been damaged by the factors mentioned above causes hyperacidity and peptic ulcers.

Peptic Ulcers, Heart burn and hyperacidity

Heart burn is a sign of reflux of gastric acid from the stomach up the esophagus to the throat. Heartburn and hyperacidity are among the commonest digestive problems. These afflict 20-30 per cent of all people at any time in their lives. The digestion of protein and fat rich foods like meats and nuts requires acid. That is why high protein foods like red meats & nuts stimulate the secretion of large amounts of acid in the stomach. 

Alcohol, fat and spices also increase gastric acid secretion and hence alcohol is often used as an "aperitif" or digestive. High protein and high fat foods, like sweets, chips, fried foods like cutlets and fried meats all predispose to hyperacidity as they stimulate secretion of gastric acid. Alcohol, cigarette smoking, coffee, and acidic foods are important causative factors for hyperacidity. These problems may also be caused by anxiety, stress, hiatus hernia or by wrong foods. The ideal treatment for these conditions is to regulate the diet.

If the valve at the junction between the oesophagus and the stomach is loose, it causes regurgitation of the acid, when the stomach contracts. This can cause pain or burning sensation in the centre of chest, and a sour taste in the mouth, which are the symptoms of heart burn. Coffee, fried foods, gas forming foods, cigarettes, alcohol and sweets should be avoided by people who suffer from heartburn. A simple remedy for heart burn and peptic ulcers is to take a table spoon of Fenugreek seeds (methi), boil it in one litre of water for 20 minutes, discard the seeds and drink 1 cup of this liquid every 3-4 hours for 21 days. This liquid forms a protective coating on the oesophagus and the stomach, preventing the acid from coming into contact with the lining of the stomach and oesophagus and so prevents burning sensation associated with the reflux of acid. This protective coat allows the stomach lining a chance to heal.

Conventional treatment of hyperacidity is with antacids like aluminium hydroxide, calcium carbonate, and magnesium hydroxide. These neutralize gastric acid thus relieving the pain. Aluminium also damages the mucous layer and is an important cause of peptic ulcers which cause pain in the upper abdomen. The taking of antacids containing aluminium hydroxide can be hazardous. Antacids which only consist of calcium carbonate are much safer and as effective. 

The next method of treatment is to use drugs which reduce gastric acid secretion like ranitidine, omeprazole, rabeprazole etc. These methods give good relief to the problem by reducing gastric acid secretions. However as they do not tackle the cause of the problem the problem usually recurs.

Measures which reduce gastric acid prevent the stomach from carrying out an important function. This is to kill bacteria, parasites and viruses from the food as well as from the secretions swallowed from the nose throat and lungs. As a result the peptic ulcers are often infected by an opportunistic bacteria which takes advantage of the low acid level called Heliobacter Pylori. Infection with H. Pylori prevents the healing of the ulcer and may require antibiotics or homeopathic treatment to heal. 

Treatment with drugs which protect the stomach lining like sucralfate and bismuth sub oxide are a far more rational form of treatment.

Another effective alternative to antacids, is to drink cold water which cools the stomach, reducing the acid secretion. Eating of alkaline foods and avoiding high protein and fat foods, spices, alcohol, smoking and stress management are also equally effective alternatives.

I have successfully treated thousands of patients with hyperacidity and peptic ulcers who have not responded to repeated courses of antacids and anti-ulcer drugs, by telling them to stop milk and milk products. This is contrary to conventional ulcer treatment where cold milk is often prescribed as a part of the treatment. To stop the patient's milk is a cheap, safe & effective measure and the patient recovers promptly without needing any drugs.