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Indigestion

Indigestion is a condition that causes symptoms such as pain or discomfort in your upper abdomen (tummy) or chest, usually after you eat a meal. Indigestion (dyspepsia) is most common after eating but you can get it at any time. You might get it every day or once in a while. Nearly everyone will get indigestion at some point in their life.

Image showing the digestive system

Details

  • Symptoms Symptoms of indigestion

    If you have indigestion, you may have one or more of the following symptoms.

    • Pain, fullness or discomfort in the upper part of your abdomen or chest.
    • A burning feeling (heartburn).
    • Feeling sick.
    • Belching.

    Your symptoms may range from mild to severe, depending on what is causing your indigestion. They may also go very quickly, come and go, or they may be regular and last for a long time.

    You probably won’t need to see your GP if you have these symptoms as you can usually manage them at home. However, if your symptoms are severe, come on after exercising or are different to your usual symptoms of indigestion, see your GP for advice. Also do this if your symptoms get worse, or don’t improve after you take over-the-counter medicines.

    Indigestion can sometimes be a symptom of a more serious condition. See your GP if you have:

    • unexplained weight loss
    • persistent symptoms of indigestion for the first time and you’re 55 or older
    • difficulty swallowing
    • vomiting
    • blood in your vomit or faeces

    Call for emergency help if you have:

    • tightness or heaviness in your chest
    • palpitations (when you can feel your heart beating fast or irregularly)
    • sweating
    • difficulty breathing

    Occasionally a heart attack can cause indigestion-like symptoms.

  • Diagnosis Diagnosis of indigestion

    Your GP will ask about your symptoms and examine you. He or she will also ask you about your medical history.

    If you have made changes to your lifestyle and taken medicines for indigestion but they haven't improved your symptoms, your GP may recommend further tests. These may include the following.

    • Breath tests, blood tests or faecal (stool) tests. These will detect H. pylori.
    • An upper gastrointestinal endoscopy (gastroscopy). This is a procedure to look inside your oesophagus, stomach and the first part of your small bowel (duodenum). During a gastroscopy, your doctor may take a biopsy (a small sample of tissue). This will be sent to a laboratory for testing.
    • A barium meal X-ray. If you have a barium meal, you will be asked to drink fluid containing barium (a substance that shows up on X-rays). X-ray images of your abdomen will then show the inside of your stomach and small bowel more clearly.
  • Treatment Treatment of indigestion

    Self-help

    There are a few things you can do to reduce the symptoms of indigestion, which include the following.

    • Lose excess weight.
    • Cut down on foods that you think may trigger your symptoms. It may help to keep a food diary to track what you eat and your symptoms.
    • Stop smoking.
    • Drink less alcohol.
    • Sleep in a more upright position by raising the head of your bed with blocks of wood or bricks.
    • Don’t eat within three to four hours of going to bed.
    • Try to reduce your stress levels.
    • Eat a healthy, balanced diet.
    • Don’t eat too much or too quickly.

    Medicines

    Over-the-counter medicines

    You can buy a range of indigestion medicines from your pharmacist without a prescription. Always read the patient information leaflet that comes with your medicine and if you have any questions, ask your pharmacist for advice.

    Antacids are medicines that can relieve symptoms of indigestion by neutralising acid in your stomach. They usually contain magnesium or aluminium. They work quickly but usually only for a short time.

    If antacids don’t work, or you need to take them frequently to relieve your symptoms, your pharmacist may recommend H2 receptor antagonists (H2RAs). These work by reducing the amount of acid that your stomach produces. They don’t work as quickly as antacids but their effect lasts for longer. Examples of H2RAs are cimetidine and ranitidine.

    If your symptoms continue, your pharmacist may suggest you try a low dose of another type of medicine called a proton pump inhibitor. Proton pump inhibitors work by reducing your stomach acid. You can take an over-the-counter proton pump inhibitor for up to four weeks.

    Prescription-only medicines

    If a proton pump inhibitor controls your symptoms well, your GP may prescribe you one for longer-term use (depending on your individual circumstances). Your GP will usually suggest you take a lower dose once your symptoms are under control. Alternatively, you may be prescribed a H2RA. Ask your GP for more information.

    If you have an H. pylori infection, your GP may recommend you take a combination of antibiotics to kill off the bacterial infection. To get rid of H. pylori you usually need to take a proton pump inhibitor combined with two different antibiotics for a week.

    Always ask your GP for advice and read the patient information leaflet that comes with your medicine.

    Surgery

    Surgery for indigestion is now rare. However, if your quality of life is severely affected you may be offered an operation. You will usually only be recommended surgery if medicines haven’t worked or you don’t want to take proton pump inhibitors for long periods of time.

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  • Causes Causes of indigestion

    Indigestion can be caused by a number of health conditions (see Underlying health conditions below). You’re also more likely to get indigestion if you’re overweight. Sometimes the cause isn't clear. However, certain things may trigger the symptoms of indigestion, such as:

    • drinking too much alcohol
    • eating certain foods, such as spicy or fatty foods
    • smoking
    • stress and anxiety
    • medicines, such as aspirin and non-steroidal anti-inflammatory medicines (NSAIDs)

    Underlying health conditions

    Some health conditions can cause symptoms of indigestion.

    • Having a peptic ulcer can cause symptoms of indigestion. This is a break in the lining of your stomach or small bowel. You can get a peptic ulcer if stomach acid, which helps digest your food, damages your stomach lining. Bacteria called Helicobacter pylori that sometimes live in your stomach can also damage your stomach lining by increasing acid production. However, not everybody infected with H. pylori will get a peptic ulcer.
    • A condition called gastro-oesophageal reflux disease (GORD) may cause indigestion. This is when acid leaks out of your stomach and into your oesophagus (the pipe that goes from your mouth to your stomach).
    • Stomach (gastric) cancer can also cause the symptoms of indigestion.
    • Other conditions can cause symptoms that are the same as those of indigestion. Occasionally these can be caused by a heart attack.

    Pregnancy

    You may get indigestion during pregnancy. This may be triggered by changes to the levels of the female hormones progesterone and oestrogen. As your uterus (womb) expands to accommodate your growing baby, this may also cause symptoms of indigestion as it presses on your stomach.

  • FAQs FAQs

    I often feel bloated after eating and have a lot of wind, which I find embarrassing. What can I do about this?

    Answer

    Usually, gas passes out through your rectum (flatulence) or out through your mouth (belching). When gas doesn’t pass out of your body easily, it can cause bloating and discomfort. If you make some changes to your diet, it may help to ease your symptoms.

    Explanation

    Every time you swallow, you take air into your stomach. Belching happens if you swallow excessive amounts of air. Eating or drinking quickly, chewing gum and smoking all add to the amount of air you swallow. If you’re under a lot of stress, you may swallow a lot of air without even noticing it. Therefore, if you stop smoking, try to reduce your stress levels and eat and drink more slowly, it may help to relieve your symptoms.

    You also produce gas in your bowel when food you’ve eaten is broken down to be absorbed. This gas passes out through your rectum as flatulence.

    It may help to reduce the amount of fizzy drinks you drink as they cause your stomach to produce more gas. Certain foods, such as beans, can also increase how much gas you produce. When these foods are broken down by bacteria in your large bowel, they form gas.

    If you have lactose intolerance, your stomach and small bowel can’t break down a sugar called lactose, which is found in milk. As a result, lactose enters your large bowel where again, the bacteria break it down and this produces large amounts of gas. Your GP can carry out a test to see if you can break down lactose. If you have lactose intolerance, your GP may advise you to reduce the amount of milk you drink.

    If your symptoms don’t get better after you make changes to your diet, or they get worse, contact your GP for advice.

    My indigestion is caused by gastro-oesophageal reflux disease (GORD). What does this mean and what can I do to help my condition?

    Answer

    Gastro-oesophageal reflux disease (GORD) occurs when the contents of your stomach are brought back up into your oesophagus. This is the pipe that goes from your mouth to your stomach. When this happens, the acid in your stomach causes a burning sensation known as heartburn.

    Explanation

    If you have GORD, it’s likely that the valve at the join between your oesophagus and stomach doesn’t work properly. Usually the valve relaxes so that you can swallow food and then closes again. If you have GORD, your valve doesn’t close after you swallow. This means some of your stomach contents can come back into your oesophagus.

    It’s not clear why this valve stops working. Some lifestyle factors are thought to aggravate the condition. For example, eating large meals, being overweight, smoking or eating fatty foods, chocolate or drinking alcohol or caffeine.

    You can buy several medicines over the counter from your pharmacist to help relieve your symptoms. These include antacids, which act by neutralising the acid in your stomach. Some medicines also contain a substance called an alginate, which forms a barrier that floats on top of your stomach contents to prevent reflux.

    Always read the patient information leaflet that comes with your medicine and if you have any questions, ask your pharmacist for advice.

    You can also make some lifestyle changes to help your symptoms. Keep a diary of what you eat and when you get heartburn – this may help to identify if a particular food is causing the problem. You can then try not eating it to find out if your symptoms improve.

    It might also help to cut down on how much alcohol you drink, stop smoking and to lose any excess weight. Eat smaller meals and have your evening meal three to four hours before you go to bed as this may also help.

    Why is indigestion common in pregnancy?

    Answer

    You may develop symptoms of indigestion (dyspepsia) when you’re pregnant because of a change in the levels of your hormones, progesterone and oestrogen. You can also develop it because your growing baby in your uterus (womb) presses against your stomach. This can increase your likelihood of having acid reflux.

    Explanation

    Between four and eight in every 10 women in the UK are thought to get indigestion at some point during pregnancy. The main symptoms of indigestion include:

    • pain, fullness or discomfort in your chest or the upper part of your abdomen (tummy)
    • a burning feeling (heartburn)
    • feeling sick
    • belching

    Symptoms of indigestion may start at any time during your pregnancy. You’re more likely to get indigestion if you had it either before you were pregnant, or during a previous pregnancy. Once you get symptoms, the chances are you’ll carry on having them as your pregnancy progresses. However, they should improve very quickly after your baby is born, once your hormones return to the levels they were at before you got pregnant.

    Contact your GP for advice if you’re pregnant and develop indigestion. He or she may recommend you take antacids as these are safe to take during pregnancy.

  • Resources Resources

    Further information

    Sources

    • Dyspepsia – unidentified cause. NICE Clinical Knowledge Summaries. cks.nice.org.uk, published November 2012
    • Indigestion. British Society of Gastroenterology. www.bsg.org.uk, accessed 1 May 2014
    • Map of Medicine. Dyspepsia. International View. London: Map of Medicine; 2013 (Issue 4)
    • Dyspepsia. PatientPlus. www.patient.co.uk/patientplus, published 14 December 2011
    • Dyspepsia: management of dyspepsia in adults in primary care. National Institute for Health and Care Excellence (NICE), 1 August 2004. www.nice.org.uk
    • Indigestion. Core. www.corecharity.org.uk, published 2 July 2013
    • Chest pain of recent onset: assessment and diagnosis of recent onset chest pain or discomfort of suspected cardiac origin. National Institute for Health and Care Excellence (NICE), March 2010. www.nice.org.uk
    • Dyspepsia – proven non-ulcer. NICE Clinical Knowledge Summaries. cks.nice.org.uk, published December 2012
    • Dyspepsia. The Merck Manuals. www.merckmanuals.com, published November 2013
    • Peptic ulcer disease. Medscape. www.emedicine.medscape.com, published 7 June 2012
    • Dyspepsia – proven GORD. NICE Clinical Knowledge Summaries. cks.nice.org.uk, published November 2012
    • Gastric cancer. Medscape. www.emedicine.medscape.com, published 28 April 2014
    • Dyspepsia – pregnancy-associated. NICE Clinical Knowledge Summaries. cks.nice.org.uk, published December 2012
    • Joint Formulary Committee. British National Formulary (online) London: BMJ Group and Pharmaceutical Press. www.medicinescomplete.com, accessed 2 May 2014
    • Gastroesophageal reflux disease. Medscape. www.emedicine.medscape.com, published 16 April 2014
    • Gas-related complaints. The Merck Manuals. www.merckmanuals.com, published November 2013
    • Lactose intolerance. PatientPlus. www.patient.co.uk/patientplus, published 10 December 2013
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    Reviewed by Rachael Mayfield-Blake, Bupa Health Information Team, May 2014.

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