Dear Dr Peg,
Sometimes after I eat I get stomach pain. Usually if I chew an antacid tablet, that takes care of it, but sometimes I have to chew several. My aunt is a nurse and she told me I might have an ulcer. How do I know? Should I get checked?
-Bellyache
Dear Bellyache,
It sounds like you have hyperacidity. Hyper means too much.
Acidity refers to the gastric secretions produced by your stomach, one of the main ingredients of which is hydrochloric acid. Stomach acid is normal and useful, but it sounds like your acid factory is working overtime. That is common and usually more irritating than damaging, but it can become problematic.
Our intestines are wonders of engineering and finesse. Consider what happens. Something delicious awaits you on your plate. This aromatic vision triggers your digestive system to gear up. Even before you take a bite, your salivary glands start to secrete.
Once in your mouth, the food gets reduced to manageable-sized pieces by your chompers and partially dissolved by the enzymes in your saliva. Having chewed your bite thoroughly, just like your mama taught you, you swallow, and it all goes sliding down your esophagus.
This is the tube that runs from your mouth to your stomach. It is lined with smooth muscles, which automatically contract, assisting gravity to transport your nourishment to the next level: your stomach.
The job of the stomach is to break food down even more. This is accomplished by more muscular contractions and a bunch of very strong acid. Smush, gurgle, smush, and off it goes to the small intestine, where all the nutrients get absorbed.
So far, so normal. But as you well know, it doesn’t always go so smoothly.
If your stomach produces too much acid, that can be painful right there. Especially if there is nothing in there for it to digest, it may just eat into your own stomach lining. If it does that long enough, it can cause an ulcer, which is basically a hole in your stomach.
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An ulcer can be shallow, bleeding or perforated, in increasing order of severity. A perforated ulcer means the acid ate all the way through your stomach. This is a medical emergency and trust me, you’ll know when it happens. The only surefire way to diagnose an ulcer is to have a look in there with fiber optics, which means a trip to the specialist.
On a less severe basis, too much acid is called acid indigestion.
This is probably what you have. You might also have heartburn.
Normally the stomach acid stays in the stomach, but on occasion it can flow upstream and into the esophagus. This hurts. It is acid, after all. Acid burns. Hence the term “heartburn,” which of course has nothing to do with the heart except a shared neighborhood.
Heartburn, also called reflux, is usually worse if you eat a really big meal, and if you lie down too soon after a meal. This is simply physics. A big meal stretches the stomach and displaces some acid. Lying down causes gravity to work in the wrong direction. Many acid sufferers have it worst at night. Sometimes raising the head of the bed with a low block under the bed frame can provide just enough of a downward slope to cure nighttime reflux.
Some people don’t feel a burning sensation with acid reflux. Other symptoms can be nausea, pressure, a cough or those lovely sour burps.
There are two basic ways to approach acid symptoms. First, decrease the amount of acid you are producing. Stress stimulates acid production, so do what you can to stay calm. Smoking cigarettes also increases stomach acid, as does drinking alcohol and ingesting acidic things like coffee. Some foods tend to make it all worse, but these vary a lot depending on the individual, so I won’t generalize. Knowing your own body and what it can tolerate is your best bet.
The next step beyond avoidance of triggers is neutralizing the acid. You are doing this when you chew those tablets, or when you drink an antacid liquid medication. It’s fine to do that every so often, but a steady diet of TUMS isn’t good for anyone.
If you are spending your days neutralizing your acid, you might want to look at medicines or herbs to decrease acid production. Over-the-counter medicines like Pepcid and Tagamet block production of acid in the stomach. Those are very effective, but there is some question about their long-term safety. One herbal remedy that is useful is deglycyrrhizinated licorice, or DGL.
If reflux is severe enough or goes on long enough, it can permanently damage the esophagus and even increase your risk of cancer of the esophagus. For this reason, it is a bad idea to ignore symptoms of acid reflux.
Don’t eat huge meals or lie down too soon after eating. Avoid triggers, limit your vices and use over-the-counter medicines judiciously. If this doesn’t help, or if you get worse, come see us at SHAC. Call 277-3136 for an appointment.
_Dr. Peggy Spencer is a student-health physician. She is also the co-author of “50 ways to leave your 40s.” Email your questions directly to her at pspencer@unm.edu. All questions will be considered anonymous, and all questioners will remain anonymous.
This column has general health information and cannot replace a trip to a health provider._
