Gastritis of the body and antrum of the stomach treatment

September 15, 2018
Gastroenterology
Ekaterina Ryzhkova

Many people ask: “Antrum gastritis - what is it? How should it be treated? You will find answers to these and other questions in the article. What is the role of the gastric antrum? It consists of reducing the acidity of digested foods before they enter the intestines. Products are also digested in this department. The muscles of the antrum help move the bolus of food into the duodenum and then into the small intestine.

Antrum gastritis - what is it? This is an inflammatory process in the antrum, which leads to atrophy of the segments and impaired motility of this section. Gradually, antrum gastritis develops. As a result, it turns into chronic atrophic-focal.

Development

How does antrum gastritis appear? What is it really? The development of this disease occurs due to the development of a large number of microorganisms in the stomach cavity. The most important role is played by the microbe Helicobacter pylori, which penetrates the stomach, causing atrophy and inflammation of mucosal cells. Due to the proliferation of bacteria, the production of bicarbonates by the glands of the antral zone is reduced. This is why the acidity of gastric juice increases.

Acid enters the intestines and irritates it. The digestion process is upset, which leads to diseases of the small intestine. The pyloric region is oxidized, and atrophic changes occur. As a result, the stomach glands die. Instead, scar tissue appears.

Antrum gastritis can progress against the background of autoimmune processes in the body. The activity of the glands is disrupted, the cells of the mucous membrane become inflamed and destroyed. This can contribute to the development of a chronic disorder of the secretory function of the mucous membrane. Very often, antral gastritis causes the appearance of ulcers and erosions in the cavity of the duodenum or at the exit from the stomach.

Complications of antrum gastritis and preventive measures

Antral gastritis, the treatment of which requires a careful and responsible approach, can lead to the following serious consequences:

scars on the walls of the gastrointestinal tract;
bulbitis (inflammation of the duodenal bulb);
change in the shape of the stomach;
intestinal slagging;
frequent fainting;
insomnia;
swelling of organs;
painful enlargement of organs;
anemia;
ulcers of the gastrointestinal tract;
inflammation of the pancreas;
dysbiosis;
intense bleeding;
tumors;
cancer.

Prevention of antral gastritis consists of the following general measures:

Observe personal hygiene rules.
Follow a healthy lifestyle (or at least watch what you eat, when and how much).
Minimize stressful situations.
Treat the primary form of gastritis responsibly and in a timely manner.
Treat any pathologies of the gastrointestinal tract in a timely manner.

If you strictly follow the above recommendations, you have every chance of not knowing what antral gastritis is. Only timely consultation with a doctor will help avoid severe stages of the disease and irreparable consequences.

Kinds

You already know how antrum gastritis occurs and what it is. Depending on the manifestation, the following types of this disease are distinguished:

Hyperplastic antrum gastritis. The gastric mucosa thickens, epithelial cells are replaced, which leads to the formation of many polyps and cysts.
Superficial antrum gastritis. It is characterized by damage to the upper gastric layer. This is a common form of gastritis that does not affect the glands and does not form scars. Such a disease can be focal, that is, it appears in certain areas.
Antrum gastritis with atrophy. It progresses against the background of mucosal atrophy, when the gastric glands begin to work poorly, the cells secrete less and less gastric juice, and food is not digested normally. The chronic form of this disease can cause the formation of a malignant tumor in the stomach.
Erosive antrum gastritis. This species is characterized by significant damage to the gastric mucosa. Inflammatory processes lead to erosions, form many scars, affect the gastric glands, and may be accompanied by bleeding.
Focal. With this type of gastritis, many foci of destruction of the gastric cavity and zones of atrophy appear.

What happens if you don't get treatment?

Focal antral gastritis tends to progress . If treatment is not started in time, it can develop from superficial focal (virtually asymptomatic) into atrophic focal (leading to severe complications).

According to statistics, it is antral gastritis that most often leads to peptic ulcers and precancerous conditions of the stomach, for example, Barrett's Esophagus.

Symptoms

Antral gastritis at the first stage can occur without pronounced symptoms, since the excretory function of the glands is not yet impaired. The acidity level of gastric juice is normal or slightly increased.

Over time, the disease evolves and discomfort appears. Severe pain is felt in the solar plexus area. It appears an hour and a half after breakfast, dinner or lunch, and can also occur on an empty stomach in the intervals between meals. Increased acidity promotes the formation of erosions, so the patient sometimes suffers from sharp pain in the form of contractions.

There may be belching with a sour tint and heartburn, discomfort and heaviness in the stomach, digestive system disorders: vomiting, increased gas formation, constipation and diarrhea.

Symptoms become more intense after consuming fried, spicy, smoked, alcoholic and carbonated drinks, sour vegetables and fruits, and coarse fiber. Powerful attacks with rapid breathing and heartbeat, weakness, and dizziness may occur.

How is diagnosis carried out?

In order to resolve the issue of diagnosis and treatment, the doctor prescribes mandatory tests:

a general blood test may show signs of anemia;
urine uropepsin determines the type of acidity of gastric juice;
by analyzing stool for occult blood, erosive damage can be suspected in the early stages of the disease;
to confirm the presence of Helicobacter, blood tests are carried out to determine the immune composition of antibodies; enzyme immunoassay, polymerase chain reaction technique, and urease breath test are recommended;
X-ray of the stomach can detect folding disorders, narrowing of the pyloric part, and ulcerative process;
fibrogastroscopic method - establishes the degree of inflammation and the course of the disease, makes it possible to take a biopsy and identify Helicobacter microscopically.

Since the stomach is a hollow organ, ultrasound examination is of little significance.

The urease breath test detects ammonia and carbon dioxide obtained during the processing of urea by Helicobacter.

Medicines

How to treat antrum gastritis? Therapy should be carried out comprehensively. It should include folk remedies, various medications and a special diet. Antibacterial therapy is very often used. To suppress and eliminate the bacterium Helicobacter pylori, antibiotics are used: Amoxicillin, Metronidazole and others. Doctors also prescribe other drugs that regulate the secretion of hydrochloric acid and reduce acidity (Omeprazole, Ranitidine, De-nol). Phosphalugel, Almagel, and Alugastrin are used to coat and protect the stomach.

To eliminate pain, antispasmodics are used: “Platifillin”, “No-shpa” and others. To improve the digestive process and ease intestinal motility, doctors prescribe enzyme-based products (Panzinorm Forte, Mezim, Festal). To eliminate vomiting and nausea, take medications such as Domperidone and Metoclopramide.

What is Antral gastritis and how to treat it

A disease that affects the mucous membrane of the stomach, causing periodic spasms and pain, poisoning the lives of many people, is gastritis.
Both a young person and a person of middle or retirement age can detect it. Before food enters the intestines, it passes through the antrum, which helps reduce its acidity. Inflammation of the stomach can be caused by the development of a bacterial background in the gastrointestinal tract - antral gastritis.

Diet

A little later we will find out how superficial antrum gastritis is treated. Now let’s talk about following therapeutic nutrition. It is known that this is the key to a rapid recovery. The diet for this disease should be gentle. The patient will have to exclude from the diet:

salinity;
spicy, pickled, fried foods;
fatty and smoked products;
carbonated and alcoholic drinks.

All dishes must be served pureed or liquid. In order for gastric cells to recover faster, the amount of protein must be increased and the amount of carbohydrates reduced. Meals should be divided into five meals. The optimal serving size is 300 g.

For antral gastritis, doctors advise eating foods such as:

low-fat varieties of poultry, meat and fish, steamed or boiled dishes from them;
light soups with pureed cereals or vegetables, based on water or milk;
dairy products;
puree or chopped vegetables;
sweet or non-acidic fruits, berries in crushed, boiled or baked form, in the form of mousses or casseroles;
pureed and slimy porridges: rice, semolina, oatmeal, buckwheat;
dry biscuits and cookies, dried white bread;
compotes and jelly from dried fruits, weakly brewed tea.

Treatment

The first step of therapy is to eliminate the main cause of the disease, the bacterium Helicobacter pylori. Treatment of antrum gastritis includes a set of measures aimed at reducing acidity and adjusting the diet.

Drug therapy

Helicobacter pylori has a protective film that protects it from harmful factors. Even antibiotic therapy for antrum gastritis does not always give a positive result. To get rid of the bacteria, 2 drugs based on clarithromycin and amoxicillin are prescribed. The level of hydrochloric acid in the antrum is normalized with proton pump inhibitors. These include esomeprazole drugs - Nexium, Pemosar, Esomeprazole Canon.

If the bacteria cannot be destroyed, another treatment regimen is used. It includes:

antibiotics Metronidazole, Tetracycline;
one of the proton pump inhibitors;
bismuth preparations.

Increased acidity in the antrum is often associated with a lack of pantothenic acid (B5) in the body, therefore a vitamin complex is prescribed as an addition to drug therapy.

Symptoms of the disease are treated with enveloping syrups: Almagel, Fasphalugel. For heartburn and stomach pain take Rennie, Maalox, Drotaverine. During an exacerbation, absorbents are used to remove toxins - Smecta, activated carbon.

Nutritional Features

Fatty, salty, and sweet foods are excluded from the diet. Liquid, pureed dishes must be included in the menu. Meals are split, the interval between meals is no more than 3–4 hours. To avoid irritation of the gastric mucosa, dishes are eaten warm. Diet for antrum gastritis includes:

lean meat;
bird;
fish;
liquid porridge;
eggs;
vegetables;
jelly;
not sour fruits.

Products are steamed, boiled, stewed. Fried foods irritate the walls of the stomach, increasing inflammation. They are excluded from the diet.

It is difficult for a sick stomach to digest coarse fiber. During the period of exacerbation of antrum gastritis, exclude fresh vegetables and fruits. You can eat baked apples and bananas. Any errors in diet can delay recovery.

During the period of remission, the list of permitted products expands. But you need to remember that prohibited foods can cause aggravation.

Folk recipes

Alternative medicine will help restore irritated mucous membranes. Together with drug treatment, traditional recipes are recommended.

Calendula infusion

The plant has a healing effect and relieves inflammation. An infusion is prepared from dried crushed flowers or heads of calendula. To prepare, take 2 tablespoons of raw materials and pour 250 ml of boiling water. The infusion is left covered for 3 hours. Take the drink 30 minutes before meals.

Propolis tincture

The product has an antibacterial effect. Propolis blocks the activity of Helicobacter pylori and relieves irritation of the antrum mucosa. The tincture is sold at the pharmacy. To prepare the medicine, 30 drops of the product are dissolved in water or milk. The mixture is drunk an hour before meals 3-4 times a day.

Aloe with honey

To prepare a healing remedy, take half a glass of honey and 100 g of crushed plant leaves. The mixture is stirred, poured with 200 ml of Cahors and left for 5 hours. Take 1 tablespoon of the tincture before meals. The prepared mixture is enough for a course of treatment.

Aloe relieves pain and promotes rapid regeneration of affected cells. Honey reduces the concentration of hydrochloric acid in the stomach.

Sea buckthorn oil

A tablespoon of butter is dissolved in warm milk. The mixture envelops the walls of the stomach, protecting it from mechanical damage. For a therapeutic effect, drink the product before meals once a day. We wrote more about the benefits and use of sea buckthorn oil for gastritis here.

The treatment regimen is chosen based on concomitant diseases of the digestive tract and the degree of involvement of the gastric mucosa in the destructive process. Only comprehensive treatment and adherence to a diet will help get rid of the disease.

We recommend: Treatment of gastritis with honey - which is the most useful?

Antral superficial gastritis

So, we figured out the nutrition. Now let's look at superficial antrum gastritis. What is it really? This disease is one of the forms of permanent gastritis, which has a clearly defined endoscopic picture. It is characterized by:

the presence of inflammatory infiltration of the personal lamina of the gastric mucosa;
dysregenerative and dystrophic changes in outer epithelial cells.

The disease is so called because it is associated with severe destruction of the antrum of the stomach. If left untreated, a chronic form of this disease may occur, which will significantly impede full recovery.

Complications of gastritis

The disease is characterized by mixed forms - different types of the disease, be it superficial or erosive type, are combined, complement each other, one develops into another. This is the main danger of gastritis: it is very difficult to predict its course in the absence of therapy. However, most patients experience problems with:

scarring of the walls of the digestive organ and adjacent systems;
duodenitis, bulbitis, deformation and stenosis of the stomach;
intoxication, weakened immunity, dysbacteriosis;
the appearance of weakness, insomnia, depression;
the formation of severe edema;
development of ulcers, pancreatitis, anemia;
atrophy, cysts, polyps.

In severe cases, damaged cells degenerate in patients and cancer begins.

What to do?

Doctors most often begin to treat this type of gastritis by destroying the causative bacteria. This technique is standard in the fight against acid-dependent and Helicobacter-like ailments.

The first treatment option involves taking anti-inflammatory drugs. If positive dynamics of recovery do not appear with the first method, the patient proceeds to the second course, which includes medications such as Bismuth, Metronidazole and Tetracycline.

The use of various enveloping drugs and antacid medications is best agreed with your doctor.

Types and forms of manifestation of antral gastritis. Treatment

The disease progresses differently in one case or another. And the disease also behaves depending on the form and degree of development. Antral gastritis, according to medical indications, can be divided into several forms:

Acute – impact on the human body of various types of factors (bacterial, food, chemical);
Chronic – a complication of the acute form of gastritis, periodically occurring course of the disease (relapses).

The method of treatment should be prescribed only by a professional gastroenterologist, since a significant number of factors are taken into account: type, type, acidity, duration of the disease, complaints and general condition of the patient. Depending on these factors, medications are prescribed and the duration of treatment is determined.

Complex treatment consists of 3 steps:

Taking medications;
Folk remedies;
Compliance with dietary nutrition.

The general treatment regimen is as follows:

When severe abdominal pain occurs, medications are taken to relieve the pain effect (antispasmodics) - Trimedat, Nosh-pa;
Antibiotics to get rid of bacteria like Helicobacter - about 14 calendar days - Metronidazole, Amoxicillin;
Medicines that reduce the level of acidity in the stomach - Ranitin, Omez, Almagel, Gaviscon;
Enzyme-containing drugs (in case of problems with the pancreas) – Mezim, Pancreatin;
Medicines containing coating substances - antacids - De-Nol;
medications that restore intestinal microflora - Hilak Forte, Bifiform;
Vitamins (in case of anemia or vitamin deficiency) – B vitamins, Sorbifer Durules.

Based on the form of gastritis, several conditional types of the disease can be distinguished:

Chronic non-atrophic antral gastritis. It is the upper layer of the stomach that is affected. This results in the appearance of scars on the surface of the mucous membrane;
Antral reflux gastritis. The stomach is not working correctly. Digested food products are refluxed (“thrown”) from the duodenum into the stomach, resulting in intoxication of the human body;
Follicular antral gastritis. The most rare type of gastritis. The gastric mucosa has already been damaged, so follicular gastritis is chronic. Helicobacter type bacteria cause repeated inflammation of the mucous membrane. Lymphocytes (white blood cells), fighting infection, “settle” in the affected areas of the stomach and form follicles, closing the glands responsible for the production of bicarbonates. The disease is characterized by frequent but not severe abdominal pain;
Erythematous antral gastritis. It is formed due to the presence in the human body of a large number of parasitic diseases, allergens and toxins. This type of disease is characterized by: heartburn, nausea after eating food, lack of desire to eat, periodic diarrhea, stomach pain and burning sensation;
Focal antral gastritis. The focal form of the disease is diagnosed by point (in a certain part) pain in the abdomen. The acidity of gastric juice exceeds the norm.

Dietary nutrition must be observed for 10 calendar days;
Taking medications that reduce gastric acidity - 10 calendar days;
Taking medications to relieve pain in the abdomen;
Taking medications that can coat the gastric mucosa and create a protective film;
Taking antibiotics if the cause of gastritis of the stomach involves Helicobacter pylori bacteria.

How to use traditional methods?

When treating antral superficial gastritis, you can use the traditional methods mentioned above. I would like to add that with this form of gastritis it is also good to take a decoction of rose hips, which contains vitamins that increase immunity.

To prepare it, place rose hips (two tablespoons) in a saucepan and pour a glass of boiled water over them. You can also add plant leaves there. Boil this mixture over low heat for 10 minutes, then strain.

Take 1/3 cup of rosehip decoction before meals. Continue treatment for a month. Take a week break and then repeat the course.

Varieties

Medicine knows several classifications of chronic antral gastritis, depending on the nature and severity of such a disorder.

The first is to divide the disease according to the mechanism of its progression:

superficial - localized in the outer layer of the mucosa. It is the mildest form of the disease;
erosive - a complicated form of the disease, characterized by significant damage and the formation of ulcers on the deeper layers of the stomach. It is expressed by symptoms such as the presence of blood in the vomit and black stool. With significant blood loss, there is a possibility of death;
focal – indicates local damage to the membrane and the presence of atrophy;
hyperplastic – characterized by a significant increase in the mucosa and the appearance of neoplasms in the form of ulcers;
catarrhal - is a superficial gastritis of the lower part of the antrum of the stomach;
atrophic - can lead to gastric failure, and is also a precancerous condition.

Depending on the severity of the course, this disease is divided into:

mild form - in which there is a slight change in the cells of the affected organ;
moderate degree - manifested by atrophy;
severe course - significant atrophy and infiltration of stomach tissue is observed.

What can you eat?

With antral superficial gastritis, it is imperative to follow the strict diet that we described above. In addition, you need to give up bad habits, try to avoid mental and nervous overloads that negatively affect the condition and level of gastric secretion.

If folk remedies and diet do not provide the desired effect, consult a gastroenterologist and undergo a complete instrumental and laboratory examination. All this will allow you to accurately determine the type of gastritis.

Disease prevention

The development of hyperplastic, erythematous or other antral gastritis can only be prevented by maintaining a healthy lifestyle. Prevention closely borders on protection from provoking factors:

you need to give up smoking and alcohol abuse;
it is important to lead a measured lifestyle without unnecessary stress and worries;
diet is a necessary condition for a healthy body;
Medicines must be taken under the strict supervision of doctors.

There are no “safe” types of disease that do not need to be treated. Moreover, even the primary catarrhal stage already indicates serious changes in the body. But timely detection of antral gastritis in any form will help the patient quickly get rid of provoking factors. If a person makes every effort to recover (diet, daily routine, giving up bad habits, systematically taking medications and folk remedies), then the pathology will go into stable remission.

Source

Inflammation of the pyloric part of the stomach (superficial antral gastritis) is a chronic disease and occurs only in cases of advanced acute gastritis.

The human stomach has an elongated shape and is conventionally divided in medicine into 3 sections - upper, body of the stomach (middle) and lower. The antrum (also known as pyloric) is the lower section. In it, food is ground, bicarbonates are produced, which break down food, as well as mucus, which covers the gastric mucosa to prevent injury to it by hydrochloric acid. From this section, food moves to the small intestine.

Another type of antral gastritis is erosive

So, how is erosive antrum gastritis treated? This type of permanent gastritis is difficult to treat. And in case of advanced disease, serious complications are possible. When starting treatment for antral gastritis, the patient must first cleanse his body. To do this, you need to fast for one or two days. During such a strict diet, the patient can only eat mineral water or black (weak) tea. Fasting gives the stomach the opportunity to rest a little and restore its digestive functions.

The next stage is therapeutic nutrition, which consists of frequent consumption of pureed and boiled dishes in small portions, as well as soups with water. Along with unusual food, a course of topical antibiotics (for example, Tetracycline) or beta-lactam antibiotics from the penicillin group (Bismuth subsalicylate, Metronidazole) is also prescribed. Another form of therapy is also used, in which proton pump inhibitors are prescribed. As a rule, the duration of treatment varies from a couple of weeks to one month.

Also, this type of gastritis can be treated with folk remedies, which we wrote about above.

Drug therapy and dietary nutrition

After diagnosis, a qualified specialist determines how to treat antral gastritis. When choosing medications, the doctor is guided by the form of the disease, the patient’s condition, the nature of the disease, possible concomitant diseases, etc.

Goals of drug therapy:

stabilize acidity;
normalize gastrointestinal functions;
increase mucus secretion to protect the epithelium from acid corrosion;
destroy Helicobacter pylori.

Only the attending physician determines the course of medications.

Do not self-medicate.

Another important condition for recovery is the quality of nutrition.

Diet for antral gastritis implies:

Strict compliance with all regulations.
Eating small portions 6-7 times a day.
Consuming food at room temperature.
Prohibition on food that stimulates secretion.
Stewing, boiling and baking dishes.

Allowed products for consumption:

exclusively boiled chicken and rabbit meat;
fish;
steam cutlets;
pureed vegetables;
porridge;
light soups;
sweet berries;
weak tea, water with lemon.

For antral gastritis, the diet implies a categorical ban on the following foods:

chocolate;
spices;
spicy and smoked products;
alcoholic and carbonated drinks;
semi-finished products and fast food;
canned, fatty and fried foods;
baking;
products that cause fermentation (dairy products, for example).

Less categorically, but still with caution, you should treat:

dried fruits;
fatty meat;
products with coarse fiber.

Traditional methods of combating antral gastritis

Plantain decoction. You need to prepare 0.5 liters of grape vodka and add plantain leaves to it. Pour the liquid into an enamel-lined container and boil for 5 minutes. Strain the broth and close tightly in a glass bottle. Take 1 tablespoon orally 30 minutes before eating food.
Burdock roots. Finely chop the burdock roots and pour the contents into 1 teaspoon. For 0.5 liters of boiling water you need 1 teaspoon of chopped burdock roots. Brew overnight and leave for at least 12 hours. Close the dish with a lid and wrap it in a towel. The decoction can be drunk in half a glass while warm. The prepared infusion should be drunk 1 day in equal parts.

Potato juice. This juice is very useful in the fight against gastritis and other diseases of the gastrointestinal tract. The drink must be consumed within 5 minutes after preparation. Otherwise, the beneficial and healing properties will be lost. New potatoes are needed. Grate it on a fine grater and squeeze out the juice using fine mesh gauze. You need to drink juice before meals. You can eat food after half an hour. Duration of use – 10 calendar days.

Sea buckthorn oil. Sea buckthorn fruit oil, due to its content of vitamins E and B, helps heal wound surfaces and eliminate inflammation. Buy sea buckthorn oil and take 1 teaspoon 2 times a day (in the morning and evening before eating food). Duration of use is 1 month, then you need a break and another 1 calendar month of taking the oil. Sea buckthorn oil is the best remedy for gastritis.
Decoction of rose hips. Due to the large amount of vitamin C, iron, magnesium in rose hips, it is an excellent remedy for the treatment of gastritis. To prepare the decoction you need to: boil whole rose hips for 5-7 minutes. Store the broth in a glass container or in a sealed thermos. Storage duration – 3 days. Drink the decoction daily, 1 glass 3 times a day.

Antral gastritis: reviews of treatment

Review No. 1: I didn’t discover I had gastritis right away. I went for an examination to a gastroenterologist and as a result, I was diagnosed with chronic antral gastritis. It turned out that I had had this disease for a long time and had already become chronic. The doctor prescribed a number of medications, which I took for about 2 weeks. From the first days the symptoms began to subside, apparently antispasmodics are working well. They completed my treatment with a drug that restores intestinal microflora, since I began to have dysbacteriosis from taking antibiotics. Hilak Forte helps a lot. Now I'm on a diet.

Review No. 2: I tried several folk methods of combating gastritis. I started with the most popular - potato juice and ended with sea buckthorn oil. There was relief, but not for long. It seems to me that contacting a gastroenterologist in this case is mandatory. You can miss the turning point and get chronic gastritis. I was examined and prescribed medications. Only after taking them did I feel a complete cure for gastritis. So traditional methods are only a delay in the chronic form of the disease and the elimination of symptoms, but not a cure.

Review No. 3: For antral gastritis, I took a bunch of different medications - Omez, Metronidazole, Trimedat, Mezim, Bifiform. All medications were prescribed by a gastroenterologist. I was afraid that so many medications would make me even worse. But no, I'm getting better. Gastritis cannot be cured with medication alone; complex therapy is needed. Now I will definitely monitor my health and regular nutrition.

Antral gastritis is an unpleasant disease that you don’t want to tell anyone about. As soon as you suspect signs of gastritis, you need to contact a gastroenterologist for diagnosis and prescribing adequate treatment. The sooner medications are selected, the less harmful effects they will have on the body. Consultation with a doctor is mandatory, despite the desire to treat yourself.

Diagnostics

The examination is comprehensive and includes a number of activities:

examination of the digestive tract using an endoscope;
cytological examination for the presence of Helicobacter pylori;
analysis of stool, vomit, blood;
breath test.

Diagnosis is carried out to identify the cause of the disease and the degree of damage to the mucous membrane. If the symptoms are mild, instrumental methods are used: sounding, gastroscopy.

During an exacerbation, devices are not inserted into the esophagus. The diagnosis is made on the basis of ultrasound, x-ray or computed tomography.

Using probing, the secretory function of the stomach and the level of acidity are assessed.