What is the management for hyperacidity?

Management of Hyperacidity

The most effective management for hyperacidity includes proton pump inhibitors (PPIs) like omeprazole as first-line pharmacological therapy, along with lifestyle modifications and dietary changes to reduce acid production and symptoms. 1

Pharmacological Management

First-Line Therapy

• Proton pump inhibitors (PPIs) are the most effective treatment for hyperacidity, with onset of antisecretory effect within one hour and maximum effect within two hours 1
• Omeprazole inhibits gastric acid secretion by specific inhibition of the H+/K+ ATPase enzyme system at the secretory surface of gastric parietal cells, blocking the final step of acid production 1
• Standard dosing of omeprazole is 20-40 mg daily, with inhibition of secretion lasting up to 72 hours despite the short plasma half-life 1

Second-Line Therapy

• H2-receptor antagonists can be used for on-demand symptom relief and are particularly useful for quick relief of symptoms 2
• H2-receptor antagonists are effective but may lead to rebound hyperacidity after discontinuation, with studies showing a 36% increase in nocturnal integrated intragastric acidity after withdrawal 3

Antacids

• Antacids provide immediate but short-term relief of symptoms and can be used as adjunctive therapy 4
• Natural antacids like cold milk and broccoli have demonstrated significant acid-neutralizing effects comparable to commercial antacid preparations in in-vitro studies 4

Lifestyle and Dietary Modifications

Dietary Recommendations

• Incorporate alkalinizing foods such as broccoli, kale, cucumber, and milk products which help restore natural gastric balance and reduce burning sensation 4
• Avoid acidic foods, caffeine, alcohol, and spicy foods that can trigger or worsen hyperacidity 4
• Small, frequent meals rather than large meals help prevent excessive acid production 4

Lifestyle Changes

• Elevate the head of the bed by 6-8 inches to prevent nocturnal acid reflux 2
• Weight loss for overweight patients can significantly reduce symptoms of hyperacidity 2
• Smoking cessation is essential as smoking increases acid production and impairs healing 5
• Stress reduction techniques may help as stress can exacerbate hyperacidity 5

Special Considerations

Long-term PPI Use Concerns

• Long-term PPI use may be associated with increased risk of osteoporosis-related fractures, especially with high doses used for extended periods 1
• Daily treatment with acid-suppressing medications over long periods (>3 years) may lead to vitamin B12 deficiency due to malabsorption 1
• Hypomagnesemia has been reported rarely in patients treated with PPIs for at least three months 1
• PPI use is associated with an increased risk of fundic gland polyps with long-term use, especially beyond one year 1

Herbal Alternatives

• Herbal preparations have shown effectiveness in treating hyperacidity and can supplement conventional treatments 5
• Commonly used herbs include mucus-containing plants (Lini semen, Althaeae radix) and anti-inflammatory volatile-oil containing herbs (Chamomillae anthodium) 5
• Neem bark extract has demonstrated potent gastroprotective and antiulcer effects in animal studies, with mechanisms including inhibition of acid secretion 6

Treatment Algorithm

1. Initial Management:

   • Start with lifestyle and dietary modifications 4
   • For mild symptoms: Use antacids or H2-receptor antagonists on demand 2

2. For Persistent Symptoms:

   • Initiate PPI therapy (omeprazole 20 mg daily before breakfast) 1
   • If inadequate response after 2 weeks, increase to 40 mg daily 1

3. For Severe or Refractory Symptoms:

   • Consider twice-daily PPI dosing 1
   • Evaluate for underlying conditions (H. pylori infection, NSAID use) 2
   • Consider combination therapy with PPI and H2-receptor antagonist, particularly for nocturnal symptoms 2

4. Maintenance Therapy:

   • Use lowest effective dose of PPI for shortest duration appropriate 1
   • Consider step-down therapy to H2-receptor antagonists after symptom control 2
   • Monitor for potential long-term complications of acid suppression therapy 1

Monitoring and Follow-up

• Patients should be reassessed after 4-8 weeks of therapy to evaluate symptom response 2
• For those requiring long-term PPI therapy, consider monitoring magnesium levels, especially if taking other medications that may cause hypomagnesemia 1
• Patients on prolonged PPI therapy should be monitored for vitamin B12 deficiency 1
• If symptoms worsen or change in character, further investigation with endoscopy should be considered 2