16.01 Agents to Control Acidity

Dyspepsia (abdominal discomfort) is often triggered by particular foods (spicy, high fibre, fatty) or by eating too quickly or overeating. Heartburn (pyrosis) is painful, burning sensation in the throat (oesophagus), which is caused by the back-up of acid from stomach into the oesophagus leading to heartburn. Dyspepsia and heartburn are treated mainly with antacids, and if serious and ongoing, with proton pump inhibitors, and sometimes histamine H₂-receptor antagonists.

In gastroesophageal reflux disease (GERD, or gastrooesophageal to give GORD) there is heartburn and regurgitation. In GERD, the lower oesophageal sphincter is either weakened or opens too often. The sphincter defect can be caused by a hiatus hernia, obesity or pregnancy. If untreated, GERD can lead to cancers of the oesophagus. GERD is treated with antacids, proton pump inhibitors, and histamine H₂-receptor antagonists.

Peptic ulcers are due to an imbalance between mucosal defence factors and aggressive factors leading to excessive acid production, as discussed in Section 7.6.1. Helicobacter pylori infection is commonly associated with these ulcers. Treatment is with antibiotics to overcome the infection and with proton pump inhibitors to overcome the excessive acidity.

Ulcers can also be induced by the Non-Steroidal Anti-Inflammatory Drugs (NSAIDs) that are non-selective inhibitors of cyclooxygenase (COX) (e.g. aspirin). The ulcers are due to the removal of the cytoprotective prostaglandins. The treatment of NSAIDs-induced ulcers is proton pump inhibitors or misoprostol.