Gastric hyperacidity: when to worry

Occasional heartburn are not worrying disorders, but if they become a constant problem it is essential to resort to the use of drugs that limit the onset of more serious problems.

Heartburn is a very frequent disorder. If associated with a binge or, in any case, a meal a little too heavy should not raise too many concerns. But if the problem is often repeated, damage to the gastric wall can be serious and the use of drugs becomes indispensable.

Do you have acidity problems after lunch? Listen to the advice of our pharmacist.

When the stomach is vulnerable

The burning sensation in the stomach associated with the presence of excess acid and is due to an imbalance between aggressive factors (first of all gastric juices) and the defensive barriers of the gastric wall.

In fact, in gastric juices there are hydrochloric acid and pepsin, the enzyme responsible for the digestion of proteins. Both factors that would damage the mucosa that covers the inside of the stomach if it were not covered by a protective barrier, formed by mucus and bicarbonate.

The production of other protective substances, such as prostaglandins, completes the effectiveness of this barrier.

However, there are external factors that can increase the production of gastric juices and reduce defense mechanisms. Gastrointestinal drugs, stress, alcohol, Helicobacter pylori and improper nutrition expose the stomach to risk of damage.

Thus appears the burning sensation which, in the long term, can lead to inflammatory processes (gastritis and reflux esophagitis) or, in severe cases, to the formation of ulcers, that is, erosions and perforations of the gastric mucosa.

The aggravation of the situation is accompanied, in addition to burning, by pain and cramps associated with regurgitation, aerophagia and general malaise, especially after meals and during the night.

How and when to run for cover

Occasional hyperacidity can be solved by following simple dietary rules: avoid too large meals and eat regularly, limiting the consumption of irritating foods and drinks (such as coffee, alcohol and dishes that are too spicy or fatty).

And, when it appears, it can be solved by using antacid drugs based on bicarbonates and alginates.

If the problem becomes frequent, especially if it is associated with injuries or real gastric ulcers, esophageal reflux, increased acid secretion or damage associated with the use of gastrointestinal medicines, it is better to resort to the use of antisecretory drugs.

To this class belong both inhibitors of H2 receptors and inhibitors of the proton pump (PPI). However, the former have a limited power of action and are not effective in counteracting after-lunch gastric acidity.

PPIs, on the contrary, have a greater antacid effect and that lasts throughout the day. Their action consists in inhibiting the production of acid by the cells of the gastric mucosa. Thus eliminating at the root the cause of the burning sensation and the possibility of damage to the stomach wall.

Currently in Italy there are five different PPIs (omeprazole, lansoprazole, pantoprazole, rabrepazole and esomeprazole), all useful to counteract ulcers associated with the presence of Helicobacter pylori and for the short-term treatment of esophagitis.

For the prolonged treatment of Helicobacter-negative ulcers, lansoprazole is recommended, while only omeprazole-lanzole, lansoprazole and lansoprazole are used to prevent and treat NSAID lesions.