Just as sparking embers can burn the carpet surrounding a fireplace, acid that escapes from the stomach can burn the oesophagus, causing the pain and discomfort of indigestion. Learn how medicines help relieve the flame.
When digestion is as it should be
Normal digestion is quite amazing. Your digestive system is basically a nine-metre long tube from your mouth to your bowel; it contains its own nervous system with almost as many nerve cells as the spinal cord and it’s also a hormone factory, producing at least 18 hormones.
The stomach lies at the centre of the digestive system and is designed to receive, store, break down and partially digest food. 9-year-old Rhiannon Williams describes digestion in the stomach:
‘Our stomach walls squeeze and churn
Then gastric enzymes take their turn
Acid and bile dissolve our food
The proteins, carbs and fat we’ve chewed.’
Stomach acid is extremely strong: it can corrode coins, and would also burn the lining of the stomach itself if it were not covered by a protective mucous layer.
When digestion goes wrong
The oesophagus (food pipe) is, however, not protected by a mucous lining. If acid is pushed up from the stomach into the oesophagus, it will burn, causing indigestion; ulcers, bleeding and an increased cancer risk are also possible. Obesity, pregnancy, tight clothing and hiatus hernia can all displace stomach acid in this way.
The stomach itself is not completely fire-retardant: smoking, alcohol, caffeine, some painkillers and drugs for arthritis and bacterial infection with H. Pylori can alter the acid/mucous balance, leading to acid burning the stomach lining.
Quenching the fire of indigestion
Just as a fireguard can restrain sparking embers, there is a muscular valve between the stomach and oesophagus to stop fiery acid escaping.
Losing weight, elevating the head of the bed, eating small meals often and avoiding tight waistbands can help this valve to remain shut. Sometimes stomach surgery, known as fundoplication, can further strengthen the barrier between the stomach and oesophagus.
Common anti-nausea medicines such as metoclopramide and domperidone can make the valve contract more strongly, while medicines such as Gaviscon and Peptac (known as ‘alginates’ since they are derived from seaweed) prevent acid reflux into the oesophagus by forming a thick gel on the surface of stomach contents.
If the embers escape the hearth and begin to burn the carpet, the fire needs putting out. Antacids such as Rennies neutralise stomach acid. Other fire extinguishers include H2-blockers such as ranitidine and cimetidine. These block the actions of histamine in the stomach, which normally stimulates acid production.
Proton pump inhibitors include omeprazole and lansoprazole which work by blocking acid production. They are very effective and widely used, though a current study is investigating a possible small increased risk of bone fractures after taking certain types of these drugs for many years.
They are used in combination with antibiotics if bacterial infection is the cause of indigestion.
When the fire won’t go out
Most indigestion is easily treated. However, if the fire of your indigestion resembles magic relighting birthday candles, and always flares up again, it is worth seeing a doctor to rule out anything more serious.
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