Hyperacidity

By Tedler D. Depaynos, MD

We were having our usual unending cups of coffee when the friend of my elder colleague suddenly appeared. He was as usual limping with a wooden cane and he appeared to be pale and obviously have lost weight. His unending jokes however were still there but his smile appeared to be shortened by attacks of pain from time to time as he changed his position. He later admitted that he was just discharged from the hospital and his “arthritis” was still bothering him.
He was taking his usual “herbal” medicines for his “arthritis” when his supplier ran out of stock. He was then offered “Chinese” medicines which he gladly accepted because he was assured that they were more effective. He then went to the province planning a short visit to his past loved ones but because of a series of enjoyable events, his stay was extended. He began to experience recurrence of his “arthritis” which was becoming more severe despite the alleged “Chinese medicines” he was taking. He was blaming the irresistible “pig entrails” which were especially served to them accompanied by unlimited supply of native alcoholized water. Because of the pain which made his wooden cane useless he shifted to the old reliable non-steroidal analgesic drugs or NSAID which were the only ones available in their local pharmacy. Specifically, he took Ibuprofen and diclofenac and knowing their side effects from experience, he took them with food. Despite his precautions however he began to feel nauseated, began vomiting whenever he took in food and started feeling epigastric pain which he labeled as “hyperacidity”. He then started taking Maalox for his “hyperacidity” but to his surprise it seemed that it was no longer effective. Hence, aside from his “arthritis,” he was also having uncontrollable abdominal pain. Because of this he requested to be brought back immediately to the city and be rushed directly to the hospital for admission. He admitted that it was his fault for yielding to the prohibited temptations.
According to him, the young MD who attended to him looked initially amateur and inexperienced but after several days he learned that he was a Gastro-specialist who trained somewhere in Metro Manila. He was very thorough in explaining to him his condition. In one occasion, he observed that the doctor raised his voice once when he started contradicting him.
From the young specialist he confirmed that his manifestations of nausea and vomiting, bloated abdomen with epigastric pain were non-specific and are called in general “dyspepsia”. It may not only be due to problems in the gastro intestinal tract but may also be due to problems in the gallbladder, liver and pancreas. Hence, an ultrasound of these organs was done and fortunately they were all within “normal”. To him it was simply “hyperacidity” due to his experience in taking the NSAID anti-arthritic meds.
Because of the possibility of “peptic ulcer” and even “gastric cancer” which is more common in his advanced age, a gastro-endoscopy was done. There was no ulcer noted but the superficial layers of the stomach as well as the proximal duodenum called “mucosa” were inflamed which were termed medically as “gastritis” and doudenitis”.
Ulcers are noted when the deeper muscular layers are involved. The blood vessels located in this layer may be eroded causing bleeding. In general ulcers in the stomach are usually malignant and when seen, a biopsy is a must. A test for the presence of the bacteria H. Pylori is also routinely done also because of its role in the formation of ulcers. It is thought to weaken the mucosal lining making it very susceptible to the effects of “hyperacidity”. Again fortunately, the patient was joyous when he was assured that he had no ulcers.
Before being discharged, he was advised that the cause of his “dyspepsia” was the NSAID that he took together with the food and drinks that they enjoyed. In his mind, he just said silently “of course”. He was then lectured that for the inflammation to subside, it would take time. The pain may disappear but the inflammation would still be there. He was prescribed medications for 4 weeks to neutralize and control his “gastric acidity”.
He was also advised to take only the newer anti-arthritic drugs that do not cause gastric irritations. The “herbal” and “Chinese medicines” were apparently foreign to his attending specialist. He promised himself appearing disciplined that this time he would follow his young doctor. Because no specific anti-arthritic drugs were prescribed, he also promised my elder colleague that he will visit him in his clinic. My elder colleague just smiled because just by looking at some of the bulges in his fingers he knows the cause of his “arthritis”.