How to Determine If You Have High or Low Stomach Acid

Q: How to Determine If You Have High or Low Stomach Acid

Hello： The issue is likely caused by gastric acid refluxing into the esophagus. <br>Some cases are due to excessive gastric acid production caused by diet or psychological stress, while others may occur under normal gastric acid conditions but are exacerbated by increased abdomin

How to determine whether there is excess or insufficient stomach acid?

1.
How can one determine whether gastroesophageal reflux is caused by excessive or insufficient stomach acid, and what tests should be conducted to assess the levels of stomach acid?
2.
What treatments are available for excessive stomach acid and insufficient stomach acid?
3.
Based on my current symptoms—burning sensation, wheezing, tightness, itchy throat, phlegm in the throat, slight cough, morning bad breath, bloating, and belching—am I experiencing excessive or insufficient stomach acid? Thank you, doctor.

A-Jia, 50~59 year old female. Ask Date: 2020/05/14

Dr. Cai Anshun reply Gastroenterology and Hepatology

Hello: The issue is likely caused by gastric acid refluxing into the esophagus.
Some cases are due to excessive gastric acid production caused by diet or psychological stress, while others may occur under normal gastric acid conditions but are exacerbated by increased abdominal pressure (such as obesity or bloating) leading to reflux.
A commonly heard examination is an upper gastrointestinal endoscopy, while a 24-hour pH monitoring test is less frequently used.
Changhua Hospital cares about your health.
Dr.
Tsai An-shun.

Reply Date: 2020/05/14

More Info

Determining whether you have high or low stomach acid can be a complex process, especially when symptoms overlap with various gastrointestinal conditions. In your case, where gastroesophageal reflux disease (GERD) is suspected, understanding the underlying cause of your symptoms is crucial for effective treatment.

1. How to Determine if You Have High or Low Stomach Acid
Symptoms Analysis:
The symptoms you describe—burning sensation, wheezing, tightness, throat itchiness, phlegm, slight cough, morning bad breath, bloating, and belching—can be indicative of both high and low stomach acid.
- High Stomach Acid (Hyperacidity): Symptoms may include heartburn, sour taste in the mouth, and regurgitation of food or sour liquid. The burning sensation you feel could suggest this.

- Low Stomach Acid (Hypochlorhydria): Symptoms might include bloating, belching, and indigestion after meals, particularly with protein-rich foods. The presence of phlegm and throat irritation could also be linked to low acid levels, as insufficient acid can lead to improper digestion and fermentation of food.

Medical Evaluation:
While a physician can make an initial assessment based on symptoms, further diagnostic tests can provide clarity:
- Upper Endoscopy (EGD): This procedure allows the doctor to visually inspect the esophagus, stomach, and duodenum for signs of inflammation, ulcers, or other abnormalities.

- 24-Hour pH Monitoring: This test measures the acidity in the esophagus over a 24-hour period, helping to determine if acid reflux is occurring and whether the acid levels are high or low.

- Gastric Acid Secretion Tests: These tests can measure the amount of acid your stomach produces, helping to confirm whether you have high or low stomach acid.

2. Treatment Options for High and Low Stomach Acid
For High Stomach Acid:
- Medications: Proton pump inhibitors (PPIs) or H2-receptor antagonists can reduce stomach acid production.

- Lifestyle Changes: Avoiding trigger foods (spicy, fatty, or acidic foods), eating smaller meals, and not lying down immediately after eating can help manage symptoms.

- Stress Management: Since stress can exacerbate acid production, techniques such as mindfulness, yoga, or therapy may be beneficial.

For Low Stomach Acid:
- Supplements: Betaine HCl supplements can help increase stomach acidity, but should only be taken under medical supervision.

- Dietary Adjustments: Incorporating more fermented foods (like yogurt and sauerkraut) can aid digestion. Eating smaller, more frequent meals can also help.

- Digestive Enzymes: These can assist in breaking down food more effectively, compensating for low stomach acid.

3. Interpretation of Your Symptoms
Based on your symptoms, it is challenging to definitively categorize your condition as either high or low stomach acid without further testing. However, the combination of throat irritation, phlegm, and bloating suggests that you might be experiencing low stomach acid, particularly if you notice that protein-rich meals exacerbate your symptoms.
Conversely, if you frequently experience a burning sensation and sour taste, high stomach acid could be the culprit.

Conclusion
Given the complexity of your symptoms and the potential for overlapping conditions, it is advisable to consult a gastroenterologist for a thorough evaluation. They can recommend appropriate tests to determine your stomach acid levels and help tailor a treatment plan that addresses your specific needs. Meanwhile, keeping a food diary to track your symptoms in relation to your diet may provide valuable insights for both you and your healthcare provider.

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