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TITLE OF CASE

Intergrative approach in the management of chronic hyperacidity- A case report.

Dr Partap Chauhan

ABSTRACT

A 30-year-old male patient presented with acid regurgitation, pain over the retrosternal area, and nauseating feeling after having meals for 10 years (2019). His daily activities were getting affected owing to the symptoms he used to get severe episodes of headache which in turn affected his Quality of Life. His sleep cycle was affected as he used to get up in between sleep due to severe acid regurgitation. He took allopathic medicines and was on antacids. But the patient did not get relief. He then consulted Jiva Ayurveda. Based on clinical evaluation, the biomedical diagnosis was Chronic Hyperacidity and the Ayurvedic diagnosis was Amlapittam. The line of treatment followed was Tridosha hara. With the initiation of Ayurvedic treatments patient could taper the dose of regular antacids, and after 1 year he could completely stop the antacids. After 3 years of Ayurvedic treatments, he reported significant recovery and could stop all his regular allopathic medications.

KEYWORDS

Hyperacidity, chronic hyperacidity, amlapitta, integrative, ayurveda, jirna

INTRODUCTION

The hydrochloric acid in our stomach is needed for the digestion and breakdown of food. When there is an increase in the secretion of hydrochloric acid by the cells in the lining of our stomach, it is known as hyperacidity. These increased acid levels can cause many hyperacidity symptoms.

Causes of hyperacidity: 

Hydrochloric acid is constantly present in our bodies. Its secretion increases when there is food to be digested. Hyperacidity is a pathological increase of the acid level in our stomach. This can happen in cases of:

Some infection that causes the stomach to secrete more acid to destroy the bacteria or virus.

Inadequate food or infrequent meal timings, which cause the acid to be underutilised.

Certain genetic conditions where the stomach secretes more acid than required.

Stress of the mental and physical type.

Smoking

Increased intake of hot liquids and stimulants such as tea and coffee

Increased alcohol intake

Foods that upset the stomach and don’t suit the person, including those who are lactose intolerant or gluten intolerant.                             

Signs & Symptoms: Although hyperacidity symptoms are predominantly associated with burning, there are other symptoms too. Some other hyperacidity symptoms are described below:

Burning in the heart and chest region, above the stomach.

A burning sensation may sometimes be felt in the throat

A sour or bitter taste in the mouth that lasts for a while.

Sometimes, the hyperacidity symptoms can cause chest pain.

Due to burning in the throat, there can be a dry cough.

Asthma is also known to be a hyperacidity symptom.

Chronic sinusitis due to acid reflux.

Ear pain due to sinusitis caused by the reflux. 

Diagnosis & Treatment:  The primary diagnostic criteria for hyperacidity is medical history and clinical evaluation by the physician. 

The cause is identified, and then the apt treatment is given. Mostly the treatment of choice is antacids, and pain killers to address the pain. Diet and lifestyle plays an important role in the management of the condition. 

Prognosis: Hyperacidity is a mild condition, that can be managed well with medicine, diet and lifestyle. But if left untreated, this can become severe. Chronic (longterm) hyperacidity can result in ulcers and if the ulcers are not taken care of, it can result in perforation, which is a surgical emergency. Chronic ulcers can also become a malignancy. Prevention is better than cure.

PATIENT INFORMATION

A 30 year old male patient who presented with multiple ailments which includes acid regurgitation, pain over retrosternal area, nauseating feeling after having meals since 10 years . His daily activities were badly getting affected due to this and he used to get severe episodes of headache which in turns affects his Quality of life, including his sleep cycle because his sleep was disturbed due to severe acid regurgitation. He is on regular antacids since 1 year. 

No relevant family/genetic/surgical history. 

Psychosocial history- Disturbed sleep due to severe acid regurgitation
Mild stress

CLINICAL FINDINGS

General examination was done. 

Appetite- low
sleep- disturbed
stress +
pain + in retrosternal area. 

TIMELINE

Image 1. Timeline of events added below

DIAGNOSTIC ASSESSMENT

Modern Diagnostic parameter; The biomedical diagnosis was confirmed by the Ayurvedic physician based on the clinical evaluation. The patient was on regular antacids since 1 year. 

Table 1. Symptoms tabulated at baseline

Symptoms	Jan 2019
Heart Burn/Acidity	++++
Gas	++++
Burping	++++
Constipation	++++
Headache	++++
Allopathic medicines	continued

Ayurvedic Assessment was done based on the presenting complaints and clinical evaluation. The treating physician confirmed the Ayurvedic diagnosis as Amlapitta (Jirna).

Differential Diagnosis- 

Coronary artery disease

Achalasia

Eosinophilic esophagitis (EoE)

Non-ulcer dyspepsia

Rumination syndrome

Esophageal diverticula

Gastroparesis

Esophageal and gastric neoplasm

Peptic ulcer disease (PUD)

On the basis of the previous treatment records and clinical findings the physician diagnosed the condition as chronic hyperacidity.                               

Prognosis- Hyperacidity is a mild condition, that can be managed well with medicine, diet and lifestyle. But if left untreated, this can become severe. Chronic (longterm) hyperacidity can result in ulcers and if the ulcers are not taken care of, it can result in perforation, which is a surgical emergency. Chronic ulcers can also become a malignancy. Prevention is better than cure.

THERAPEUTIC INTERVENTION

Refer the tab ‘Treatment’ in the Portal. 

FOLLOW-UP AND OUTCOMES

The patient had 5 follow ups in total over a time period of 4 years. The last follow up done was in January 2023, which was 9 months after stopping all his medications. Each follow up, there was a significant reduction in the symptoms. 

Clinician-based assessment; In the first follow up after 2 months, there was significant reduction in symptoms. After 12 months of starting ayurvedic treatment, patient reported only mild heart burn. After 21 months, the patient got complete recovery from symptoms and the antacids were stopped. After 3 years and 3 months all the medicines were stopped. The last follow up was done after 9 months of stopping medicines, and there has been no recurrence.

Table 2. Symptoms tabulated from baseline throughout the treatment date wise

Symptoms	Jan 2019	March 2019	Jan 2020	August 2020	March 2021	April 2022
Heart Burn/Acidity	++++	+	++	+	+	Absent
Gas	++++	++	+	+	Absent	Absent
Burping	++++	++	+	+	+	Absent
Constipation	++++	+	Absent	Absent	Absent	Absent
Headache	++++	+	Absent	Absent	Absent	Absent
Allopathic medicines	continued	continued	continued	continued till Oct 2020	Stopped	Stopped

 

Patient- based assessment: Not relevant

Intervention adherence and tolerability – The patient adhered to the prescribed treatments and tolerated the treatments well. 

Method of assessment- Subjective parameters were the main assessment tools. 

Adverse and unanticipated events; None reported

 

DISCUSSION: 

Hyperacidity is a mild condition, that can be managed well with medicine, diet and lifestyle. But if left untreated, this can become severe. Chronic (longterm) hyperacidity can result in ulcers and if the ulcers are not taken care of, it can result in perforation, which is a surgical emergency. Chronic ulcers can also become a malignancy. Prevention is better than cure. In this case report, the patient had a chronic history of 10 years. He was on antacids since 1 year, but the symptoms persisted inspite of taking medicine and following a normal diet. With Ayurvedic treatments, over a period of 3 years, he got complete relief from all his symptoms, and there has been no relapse. 

 

PATIENT’S PERSPECTIVE

Not available. 

 

LEARNING POINTS/TAKE HOME MESSAGES 

 

This case report demonstrates the successful integrative management of a chronic case of Amlapitta in a 30 year old male patient who had been suffering from this condition for more than 10 years, and was not getting relief inspite of taking antacids. Last followed up, there has been no recurrence.

 

INFORMED CONSENT

Written consent obtained from patient for publishing of the case report in the Portal 

 

ACKNOWLEDGEMENTS

None

 

CONFLICT OF INTEREST

None declared.

 

FUNDING

None

 

 

REFERENCE

1. https://manmatters.com/blog/hyperacidity/
2. https://www.thehealthsite.com/diseases-conditions/hyperacidity-or-acid-dyspepsia-what-causes-it-and-how-to-avoid-it-786412/
3. Madhava Nidana. Chapter 51. Amlapitta Nidana.
4. https://www.easyayurveda.com/2021/03/10/amlapitta/