| You may be able to munch a sandwich in a couple of minutes but it takes your body a long time to tackle the problem of digesting it. In fact, from eating your lunch to getting rid of the waste material takes an average of 18 hours. As you can see from the diagram, the journey your food takes is quite a complicated one. Essentially, your digestive system is like a series of compartments each with a different role in the digestive process. |
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Ingestion
Once you have chewed your food and mixed it with saliva, it passes into the oesophagus. The enzymes in your saliva have already started the digestive process and at this point the food has become a soft paste. It gets propelled towards the stomach via the gullet by a series of muscle contractions, known as ‘peristalsis'. Digestion
Your stomach is a muscular bag closed at the top and bottom by thick muscles that act as one-way valves. The stomach wall contains special muscle fibres that start to churn the food over. Glands in your stomach then secrete acidic gastric juice which turn your food into a liquid. It may surprise you to learn that your stomach secretes as much as three litres of gastric juices a day. Stomach acid, can give rise to common problems such as indigestion or heartburn.
Absorption
After its stop-off in the stomach, your liquefied food travels to the small intestine via a further process of peristalsis. Your small intestine is actually a tube of muscle six metres long and it is here that water, fat and protein is taken from your food. This part of the digestive process is undertaken by enzymes in the gut wall, as well as by juice from the pancreas and bile from the liver. Next, the contents of the small intestine pass to the large intestine or colon. Although only 1.5 metres long, it's called ‘large' because it's much wider than the small intestine. This is where additional water, salts and minerals are removed from your food.
Our stomachs process food several times every day and they generally do an excellent job - week in, week out. However, since our digestive systems are highly-tuned and very sensitive, it's quite easy for things to go wrong. So it's probably not surprising to learn that nearly 40% population experience indigestion symptoms. In fact, it's so common that as many as 7% get it every single day. So if you find an enjoyable meal is spoiled by an uncomfortable or painful stomach and embarrassing after-effects, you're certainly not alone. But help is at hand - don't feel you have to put up with indigestion. Indigestion is the general term which refers to stomach discomfort but there are, in fact, three distinct types of problem: excess acid, trapped wind and dysmotility i.e. nausea or queasiness or heavy bloated stomach after eating. We have listed the different symptoms in the table below.
Symptom Group 1
- a burning pain just behind your breastbone (can be called heartburn)
- a rising pain in your gullet which feels like it's moving up towards your neck (can be called heartburn)
- a bitter, stinging acid taste in the back of your throat (can be called heartburn)
- belching
- sharp, sore pain the stomach (can be called acid indigestion or sour stomach.
If you have these sensations, you probably have EXCESS ACID.
Symptom Group 2
- gassy or bloated feelings
- unnaturally distended abdomen
- Flatulence
- Belching
- uncomfortable pain in your abdomen.
If you are experiencing the above symptoms, it's most likely you have TRAPPED WIND.
Symptom Group 3
- queasy, nauseous feelings
- fullness - like you've eaten lots even when you haven't
- heavy bloated stomach - like there's a brick in it
- feels like something is sitting in your stomach
- stomach ache or general discomfort rather than pinpointed pain
- If this sounds like you, then you may have DYSMOTILITY.
There is a fair amount of crossover between the different types of symptoms and you may find you don't fall neatly into any one group.
Excess Acid - The Main Causes
Excess acid is not pleasant - especially if you suffer regularly. But if you can understand what might be causing it, then you might be able to say ‘goodbye' to it once and for all. There are a number of reasons why you might produce too much stomach acid - and why it can sometimes escape into your oesophagus:
- your stomach can't cope with what you've just eaten. Certain foods are harder to digest than others and so they trigger more acid production to help break it down. Exactly what these ‘trigger' foods are will vary from person to person but generally rich, fatty or spicy meals are more likely to cause an attack.
- the muscle ring at the top of your stomach doesn't close properly which causes acid to rise up to your oesophagus. Reasons for this could include stress, smoking, excess coffee or alcohol - because all these will impair the way your stomach works.
- something is pressing on your stomach which physically pushes some of your stomach contents - including the acid - back up. This is a common problem if you are pregnant or overweight. It can also be caused by wearing tight clothing, or if you're sitting in an awkward position while eating, or lie down too soon after a meal - all can put undue pressure on your stomach.
- sometimes other medication can cause excess acid symptoms (for example, 'non steroidal anti-flammatory' drugs such as aspirin and ibuprofen.) If you think this may be the cause of your symptoms, stop taking all medication and seek the advice of a pharmacist or doctor.
How to avoid
Most of us lead hectic lifestyles and it's not always easy to change our eating and drinking habits. But if you want to take control of excess acid, here are a few tips on how to avoid quite so many attacks:
- avoid eating the trigger foods that you know will give you a problem. If you can't pinpoint which foods might be causing it, keep a note of what you've eaten and then try to cut them out, one by one. It can often be a case of trial and error for a while
- try to cut down on both alcohol and coffee, as too much of either can affect the way your stomach operates. If your stomach is functioning properly it won't allow any acid to pass backwards up into your gullet
- smoking can also impair the function of your stomach, so try and reduce the number of cigarettes you smoke. Or better still, give up altogether
- try to eat little and often, as large meals - especially eaten late at night just before bedtime - can often make excess acid worse
- if you tend to suffer more at night, raise yourself up on a couple of pillows to help keep the acid down in your stomach.
- If you are overweight you might find that excess fat is pressing on your stomach which can physically push your stomach contents into your oesophagus, leading to excess acid. You'll probably find that losing a few pounds will help
- don't wear tight clothing after a big meal because this will put pressure on your stomach and have the same effect as if you were overweight
- try and eat more slowly, as rushing your food could bring on an attack
- stress can aggravate excess acid, so try and learn some relaxation techniques such as deep breathing or meditation.
Treatment
There are typically 3 major categories of drugs to prevent heartburn:
Antacids: Usually these are available as tablets and liquids. Antacids neutralise the excess acid in your stomach. Whilst antacids provide rapid relief, they have a limited duration of action, and sometimes more than one tablet may be required to achieve a longer lasting effect, common examples are Mylanta, Maalox, Eno, alka-seltzer etc. Gaviscon is an antacid that has an additional “rafter”, the alginate will form a layer on the stomachfluid therefore helping to prevent acid reflux.
H-2 blockers or Acid Balancers : There's a cell in the stomach called a parietal cell, and that parietal cell makes acid. There are a number of different things that stimulate that cell, and one of them is histamine. H2 blockers simply prevent histamine from stimulating the parietal cell, thus reducing the amount of acid that's made. H2 blockers are quite effective at preventing heartburn attacks, and they're also pretty useful for treating other conditions such as ulcers or esophagitis that are the result of excess acid.
H2 Blockers provide a long lasting effect - which can last for up to 12 hours, however they do not work as quickly as antacids. If you expect to get heartburn from a meal you can take 1 tablet an hour before for prevention. Common examples are Zantac (ranitidine) and Pepcid (famotidine)
Proton pomp inhibitors - The difference between the way a proton pump inhibitor works and an H2 blocker is that the proton pump inhibitor is working at the site where the acid is being made and the H2 blocker is working at a site which stimulates the parietal cell. And because of that, the proton pump inhibitors generally have a more potent effect on suppressing acid secretion by the parietal cell than does the H2 blocker.
A proton pump inhibitor might be effective in those people who have they had tried an H2 blocker but had not gotten complete relief. In other words, they were still having symptoms while taking their H2 blocker and need something a little more potent to suppress enough acid to eliminate their symptoms.
In the US Prilosec (losec) is available in an otc formulation. These medications will be prescribed by your doctor, common formulations are Nexium, Pantosec and Ogastro. They take longer to give relief than the H2 blockers.
The next article will explain the possibilities with dysmotility and gas. |
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