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Indigestion

Indigestion (dyspepsia) affects around four in every 10 people in the UK every year. It's a term that refers to several symptoms, including pain or discomfort in your upper abdomen (tummy). You’re most likely to notice the symptoms after you’ve eaten, but you can get them at any time. You may get indigestion every day or once in a while.

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  • Symptoms Symptoms of indigestion

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

    • pain, fullness, heaviness, aching or discomfort in your upper abdomen (tummy) or lower chest
    • wind or bloating
    • a burning feeling (heartburn)
    • feeling, or occasionally being, sick
    • belching
    • flatulence

    Most people with indigestion don’t see their GP if their symptoms are mild. You may be able to manage your indigestion yourself by taking over-the-counter medicines from a pharmacy. But if your symptoms are severe, come on after you exercise, or are worse or different to your usual indigestion, contact your GP.

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

    • are losing weight but don’t know why
    • have persistent symptoms of indigestion for the first time and you’re 55 or older
    • are finding it difficult to swallow
    • are vomiting regularly
    • notice blood in your vomit or faeces
    • have black, tar-like stools or what looks like coffee grounds in your vomit
    • have had your symptoms for more than a few weeks

    Occasionally a heart attack can cause indigestion-like symptoms. Call for emergency help if you have the following symptoms alongside indigestion:

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

    Your GP will ask about your symptoms and what makes them better or worse (such as alcohol, exercise or certain foods). They’ll also examine you and ask you about your medical history.

    Your GP may recommend further tests.

    • Breath tests, blood tests or faecal (stool) tests. These will check you’re not losing blood, which can lead to anaemia. They can also check for Helicobacter pylori (H. pylori), which is a bacterial infection.
    • An upper gastrointestinal endoscopy (gastroscopy). This looks inside your oesophagus (the pipe that links your throat to your stomach), 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’ll be asked to drink fluid containing barium (a substance that shows up on X-rays). X-ray images will show the inside of your stomach and small bowel more clearly.
  • Self-help Self-help

    If you have indigestion, there are a few things you can do to reduce your symptoms.

    • Lose weight if you’re overweight.
    • Cut down on foods or drinks that you think may trigger your symptoms. It may help to keep a food diary to track what you eat and when your symptoms flare up and down. Common triggers include chocolate, coffee and fatty foods.
    • Stop smoking or smoke less.
    • 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 during the three hours before you go to bed
    • Eat a healthy, balanced diet
    • Eat at regular intervals during the day
    • Try to reduce your stress levels
  • Treatment Treatment of indigestion

    Medicines

    Over-the-counter medicines

    You can buy several indigestion medicines from your pharmacist without a prescription. Always read the patient information leaflet that comes with your medicine and ask your pharmacist for advice if you’re unsure about anything.

    You can take antacids for occasional symptoms. These relieve indigestion by neutralising acid in your stomach. Antacids usually contain magnesium or aluminium. You can take antacids when your symptoms occur or if you’re expecting them to flare up (such as before you go to bed). Liquid products tend to work better than tablets.

    Some indigestion medicines contain antacids with alginates or simeticone. Alginates form a raft over your stomach contents and may help if acid rises from your stomach into your oesophagus, causing heartburn. Simeticone is an antifoaming agent, which breaks down bubbles of gas in your digestive system to relieve wind and bloating.

    If antacids don’t work, or you need to take them regularly to relieve your symptoms, your pharmacist may recommend some other medicines. Proton pump inhibitors, such as omeprazole, work by stopping your stomach producing acid. You can take an over-the-counter proton pump inhibitor for up to four weeks.

    If you can’t take a proton pump inhibitor, you may be able to try H2 receptor-antagonists (H2RAs), such as cimetidine and ranitidine instead. These also work by reducing how much stomach acid you produce.

    Prescription-only medicines

    If a Helicobacter Pylori (H. pylori) infection is causing your indigestion (see our causes section below), your GP may recommend a combination of antibiotics to kill off the bacterial infection and medicines such as proton pump inhibitors to reduce the amount of acid your stomach produces.

    If a proton pump inhibitor controls your symptoms well, your GP, after assessing your condition, may prescribe one that you can take for a longer period of time. They’ll usually suggest you take a lower dose once your symptoms are under control. If you can’t take a proton pump inhibitor, you may be prescribed an H2 receptor-antagonist instead. Ask your GP or pharmacist for more information.

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

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  • Causes Causes of indigestion

    Your GP may not find a specific cause for your indigestion. But certain things may trigger off your symptoms, such as:

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

    Underlying health conditions

    Indigestion can be caused by a number of health conditions.

    You may have a peptic ulcer, which 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. A peptic ulcer can also be caused by Helicobacter pylori (H. pylori) bacteria that sometimes live in your stomach. The bacteria can damage your stomach lining by increasing the amount of acid produced in your stomach.

    Your indigestion may be caused by a condition called gastro-oesophageal reflux disease (GORD). This is when acid leaks out of your stomach and into your oesophagus. See our FAQ on GORD for more information.

    Stomach (gastric) cancer can also cause indigestion.

    Sometimes indigestion-like symptoms aren’t related to your digestive system. They may be caused by something else, such as a heart attack.

    Pregnancy

    You may get indigestion during pregnancy due to changing hormone levels and the increased pressure in your abdomen (tummy). The symptoms can start at any stage of your pregnancy. See our FAQ on Pregnancy for more information.

  • FAQ: Wind and bloating What can I do about my bloating and wind?

    Wind and bloating are very common. Changing things like your diet, and certain lifestyle factors can help to reduce your symptoms.

    More information

    You usually pass wind out through your rectum (flatulence) or your mouth (belching or burping) several times a day. You don’t notice this happening as it’s in tiny amounts each time. But when gas doesn’t pass out of your body easily, or there’s too much gas, this can cause bloating and discomfort.

    Swallowing too much air is a common cause of belching or burping. To prevent this you should avoid:

    • eating or drinking too quickly
    • chew gum
    • drinking fizzy drinks
    • smoking

    You produce gas in your bowel when the food you’ve eaten is broken down to be absorbed. Certain foods such as pulses, bran and fruit, can increase the amount of gas you produce, so try to limit these. Regular exercise may also help to reduce your symptoms.

    If your symptoms don’t get better after you make changes to your diet, or they get worse, speak to your GP. Most people with wind and bloating don’t have an underlying health problem. But flatulence can sometimes be caused by a condition such as constipation, irritable bowel syndrome or lactose intolerance.

    If you’re lactose intolerant, your stomach and small bowel can’t break down a sugar called lactose, which is found in milk and other dairy products. Instead, the lactose is broken down in your large bowel, which produces large amounts of gas. Your GP may advise having a diary-free diet for a while, to see if this is the cause of your symptoms. If you have lactose intolerance, your GP may recommend eating and drinking less milk and other dairy products.

  • FAQ: Gastro-oesophageal reflux disease (GORD) What can I do if my indigestion is caused by GORD?

    If you have GORD, your stomach acid rises into your oesophagus. You may have an acidic taste in your mouth or burning sensation in your upper chest (heartburn). Taking medicines or changing your lifestyle may help your symptoms.

    More information

    If you have GORD, it’s likely that the valve between your oesophagus and stomach doesn’t work properly. Your oesophagus is the pipe that leads from your throat to your stomach.

    Usually the valve relaxes (opens) when you swallow food and then closes again. But if you have GORD, your valve may be weak or it may relax too often. This means some of your stomach contents can come back up into your oesophagus (called reflux).

    You can buy several medicines over the counter from your pharmacist to help relieve your symptoms. These include antacids, which neutralise your stomach acid. Some medicines also contain an alginate, which forms a barrier over your stomach contents to prevent reflux. Always read the patient information leaflet that comes with your medicine. If you have any questions, ask your pharmacist for advice.

    Some foods, such as coffee, chocolate or fatty foods, may make your symptoms worse. Keep a diary of what you eat and when you get heartburn – this will help to identify if a particular food is triggering your symptoms. It may also help if you drink less alcohol, stop smoking and lose any excess weight. Try eating smaller meals and having your evening meal three hours before you go to bed too.

  • FAQ: Pregnancy Why is indigestion common in pregnancy?

    You’re most likely to experience indigestion in pregnancy because of rising hormonal levels. It may also be because your growing baby in your uterus (womb) presses against your stomach.

    More information

    Between four and eight in every 10 women in the UK are thought to get indigestion at some point during their pregnancy. This is usually caused by gastro-oesophageal reflux disease (GORD). Rising levels of progesterone and oestrogen hormones make the valve between your oesophagus and stomach more relaxed. This means some of your stomach contents can come back up into your oesophagus (called reflux).

    You may have pain or discomfort in your upper tummy or chest, with belching, nausea and a burning feeling (heartburn). Your symptoms may start at any time during your pregnancy, but these should disappear again once your baby is born. You’re more likely to get indigestion if you had it before you were pregnant or during a previous pregnancy.

    If you develop indigestion during pregnancy, contact your midwife. They may recommend you try antacids and alginates, as you can take these safely during pregnancy.

  • Other helpful websites Other helpful websites

    Further information

    Sources

    • Dyspepsia – unidentifiable cause. Clinical Knowledge Summaries. cks.nice.org.uk, last revised July 2015
    • Dyspepsia. The Merck Manual. www.merckmanuals.com, last full review/revision November 2013
    • Therapy-related issues: gastrointestinal system. Oxford Handbook of Clinical Pharmacy (online). 2nd ed. Oxford Medicine Online. www.oxfordmedicine.com, published online January 2012
    • Dyspepsia. PatientPlus. www.patient.info, last checked October 2014
    • Gastrointestinal medicine. Oxford Handbook of General Practice (online). 4th ed. Oxford Medicine Online. www.oxfordmedicine.com, published online April 2014
    • Acute myocardial infarction. PatientPlus. www.patient.info, last checked July 2012
    • Helicobacter pylori. PatientPlus. www.patient.info, last checked November 2014
    • Upper gastrointestinal surgery. Oxford Handbook of Clinical Surgery (online). Oxford Medicine online. www.oxfordmedicine.com, published online March 2013
    • Mayo Clinical Gastroenterology and Hepatology Board Review (online). Oxford Medicine Online. www.oxfordmedicine.com, published online August 2014
    • Nursing patients with nutritional and gastrointestinal problems. Oxford Handbook of Adult Nursing (online). Oxford Medicine Online. www.oxfordmedicine.com, published online August 2010
    • Gastro-oesophageal reflux disease. PatientPlus. www.patient.info, last checked April 2013
    • Antacids. Joint Formulary Committee. British National Formulary (online). London: BMJ Group and Pharmaceutical Press. www.medicinescomplete.com, accessed March 2016
    • Dyspepsia. Joint Formulary Committee. British National Formulary (online). London: BMJ Group and Pharmaceutical Press. www.medicinescomplete.com, accessed March 2016
    • Peptic ulceration. Joint Formulary Committee. British National Formulary (online). London: BMJ Group and Pharmaceutical Press. www.medicinescomplete.com, accessed March 2016
    • Dyspepsia – proven peptic ulcer. Definition. Clinical Knowledge Summaries. cks.nice.org.uk, last revised July 2015
    • Gastric cancer. PatientPlus. www.patient.info, last checked November 2014
    • Dyspepsia – pregnancy associated. Clinical Knowledge Summaries. cks.nice.org.uk, Last revised December 2012
    • History and examination. Oxford Handbook of Clinical Medicine (online). 9th ed. Oxford Medicine Online. www.oxfordmedicine.com, published online January 2014
    • Flatulence and wind. PatientPlus. www.patient.info, last checked August 2014
    • Lactose intolerance. PatientPlus. www.patient.info, last checked December 2013
    • Esophagus anatomy. Medscape. www.emedicine.medscape.com, reviewed 20 July 2015
    • Gastro-esophageal reflux disease. Medscape. www.emedicine.medscape.com, updated January 2016
    • Overview of GI bleeding. MSD manual. www.msdmanuals.com, last full review/revision January 2016
    • Personal communication. Dr Adrian Raby, General Practitioner and Clinical Lecturer, June 2016
    • Lactose intolerance. British Nutrition Foundation. www.nutrition.org.uk, accessed July 2016
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    Reviewed by Laura Blanks, Specialist Health Editor, Bupa Health Content Team, June 2016

    Peer reviewed by Dr Adrian Raby, General Practitioner and Clinical Lecturer, June 2016

    Next review due June 2019

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