Indigestion

Published by Bupa's Health Information Team, September 2010.

This factsheet is for people who have indigestion, or who would like information about it.

Indigestion (dyspepsia) is the term used to describe pain or discomfort in the upper abdomen or chest, generally occurring soon after meals.

About indigestion

You get indigestion when the acid in your stomach flows back up your oesophagus (the pipe that goes from your mouth to your stomach) or when your stomach is irritated or inflamed. Although indigestion is most common after meals, you can get it at any time.

Heartburn is a burning pain caused by your stomach acid flowing back up your oesophagus (called reflux). This occurs if the valve (sphincter) at the top of your stomach doesn't work properly. The medical term for this condition is gastro-oesophageal reflux disease (GORD).

Symptoms of indigestion

If you have indigestion you may have the following symptoms:

• pain, fullness or discomfort in the upper part of your abdomen or chest
• heartburn
• loss of appetite
• feeling sick
• flatulence (gas passed from your rectum), burping or belching

Depending on the cause of your indigestion, your symptoms may go very quickly, come and go, or they may be regular and last for a long time.

You should visit your GP for advice if you have:

• unexplained weight loss
• unexplained and continual symptoms of indigestion for the first time and you're 55 or older
• severe pain, or if the pain gets worse or changes
• blood in your vomit, even if it's only specks of blood

Causes of indigestion

Your stomach produces a strong acid that helps you to digest food and protects you against infection. A layer of mucus lines your stomach, oesophagus and bowel to act as a barrier against this acid. If the mucous layer is damaged, your stomach acid can irritate the tissues underneath.

Lifestyle triggers

Some of the following can trigger symptoms of indigestion:

• drinking too much alcohol
• smoking
• stress and anxiety
• medicines, such as aspirin and anti-inflammatory medicines, used to treat arthritis
• eating certain foods, such as coffee and chocolate, can relax the sphincter at the join between your oesophagus and stomach or cause direct irritation to the lining of your oesophagus

Being overweight or obese can increase the pressure on your stomach and contribute to feelings of indigestion.

Underlying medical conditions

Some medical conditions can cause symptoms of indigestion and heartburn.

Peptic ulcers are ulcers in your stomach or the first part of your small bowel (duodenum). They occur when the lining of either your stomach or your duodenum is damaged and becomes inflamed. Peptic ulcers are usually caused by a bacterium called Helicobacter pylori (H. pylori). These bacteria live in the mucous layer of your stomach. Although they don't always cause symptoms, they can cause peptic ulcers in some people.

Heartburn can be triggered by hiatus hernia. Hiatus hernia occurs when part of your stomach or sphincter slide up into your chest cavity, causing reflux.

Certain types of cancer can trigger the symptoms of indigestion, but this is rare.

Pregnancy

Many women suffer from indigestion during pregnancy. This may be triggered by high levels of the female hormones progesterone and oestrogen, which relax your sphincter.

Diagnosis of indigestion

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

If lifestyle changes and medicines don't help to improve your symptoms, your GP may recommend further tests, such as those listed below.

• Breath tests or blood tests to detect the presence of H. pylori.
  
• A gastroscopy - a procedure used to look inside your oesophagus, stomach and your 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 swallow and meal X-ray. This is a test that involves swallowing a drink containing barium (a substance that shows up on X-ray images). X-ray images of your abdomen then show the inside of your bowel more clearly.

Treatment of indigestion

Self-help

There are a few things you can do to reduce the symptoms of indigestion, including:

• losing excess weight
• cutting down on fatty foods, tea, coffee, alcohol and anything else that you think triggers your symptoms
• stopping smoking
• sleeping in a more upright position, propped up on a pillow (the action of gravity reduces reflux)
• eating more than three hours before going to bed if you have a peptic ulcer
• reducing your stress levels
• not eating 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 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.

Some medicines for indigestion contain an ingredient called an alginate, which forms a barrier that floats on top of your stomach contents to prevent reflux. Side-effects of antacids can include diarrhoea and constipation.

If antacids don't work, or if you need to take large quantities of antacid medicines to relieve your symptoms, your pharmacist may recommend H2 blockers. These work by reducing the amount of acid that your stomach produces. Examples of H2 blockers are famotidine and ranitidine.

If your symptoms continue after taking antacids or H2 blockers, your pharmacist may suggest that you try a low dose of another type of medicine called a proton pump inhibitor. Proton pump inhibitors work by stopping your stomach producing acid. You can take an over-the-counter proton pump inhibitor for a maximum of four weeks. Examples of these are omeprazole or lansoprazole.

Prescription-only medicines
If a proton pump inhibitor is controlling your symptoms, your GP can prescribe you one for long-term use.

If your symptoms continue after taking a proton pump inhibitor for two weeks, your GP can prescribe another type of medicine called a prokinetic. This works by making food pass more quickly through your stomach, so that you're less likely to experience symptoms. Domperidone and metoclopramide are both prokinetics.

If you have an H. pylori infection, your GP may recommend having triple therapy to kill off the bacterial infection. This usually means taking a proton pump inhibitor combined with two different antibiotics, for seven days.

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

Surgery

Surgery for indigestion or heartburn is rare. Your doctor will usually only recommend it if medicines don't work or if you don't want to take proton pump inhibitors for long periods of time.

If you have a hiatus hernia and your symptoms are severe, your GP may refer you to a surgeon. He or she may recommend that you have surgery to repair the hernia.

Talking therapies

Some people may find that talking therapies, such as cognitive behavioural therapy (CBT) and psychotherapy reduce the symptoms of indigestion.

For answers to frequently asked questions on this topic, see Common questions.

For sources and links to further information, see Resources.