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Indigestion

Published by Bupa's health information team, August 2006.

This factsheet is for people who suffer from indigestion and want to learn more about it.

Indigestion is the term used to describe pain or discomfort in the upper abdomen or chest after meals. The medical term for this is dyspepsia. Sometimes it is also used to describe a distinctive burning feeling in the chest, known as heartburn. Most people have suffered from indigestion after a large meal at some time, and up to one in four adults suffer from heartburn each year.

What are the symptoms?

The main symptoms of indigestion are:

• pain, fullness or discomfort in the upper part of your abdomen or chest
• heartburn
• loss of appetite
• feeling sick or being sick
• flatulence, burping or belching

The different parts of the digestive system

Heartburn is a burning pain caused by the stomach acid flowing back up your food tube (oesophagus). This is called reflux. The medical term for the condition is gastro-oesophageal reflux disease (GORD). You will normally feel this pain in the centre of your chest or behind your breastbone (sternum). If this is severe, it might feel similar to a heart attack.

Indigestion has several causes. Depending on what is causing your indigestion, your symptoms may go very quickly, come and go, or they may be regular and last a long time. The medical term dyspepsia refers to pain after eating, but you can get indigestion symptoms at any time.

Sometimes the symptoms of indigestion can be caused by a more serious condition such as an ulcer, or occasionally cancer. You should seek advice from your GP if you have any of the following symptoms:

• unintended weight loss
• indigestion symptoms for the first time if you are 45 or older
• severe pain, or the pain gets worse or changes

You need to seek urgent medical attention if you vomit blood, even if the blood is only present in the vomit as specks of blood or blood that looks like coffee grains.

What causes indigestion?

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

With heartburn, the valve (sphincter) at the join between the oesophagus and stomach does not work properly, allowing reflux of the stomach acid.

Some of the following things can make the symptoms worse:

• eating a heavy meal
• drinking excess alcohol
• smoking
• having irregular meals, because long gaps between meals give the acid more time to act (each meal neutralises the acid for a while)
• stress and anxiety
• drugs such as aspirin and anti-inflammatory medicines used to treat arthritis
• pregnancy
• peptic ulcer (stomach or duodenal ulcer), which is a raw patch in the lining of the stomach or the small intestine

For more information on peptic ulcers, please see the separate Bupa health factsheet Peptic ulcer

Other causes:

Helicobacter pylori (H. pylori)

This is a bacterium that lives in the mucus layer of the stomach and can cause irritation (gastritis). About half the world's population have this type of bacteria in their stomach, and often it doesn't cause any problems. However, 70 to 90 percent of people who suffer from a peptic ulcer carry H. pylori. About 15 percent of people who carry it will go on to develop an ulcer. A small proportion of people who are affected may develop stomach cancer.

If H. pylori. is diagnosed, it can be treated with a one-week course of tablets (see 'Treatment' below).

Hiatus hernia

Normally, the stomach is completely below the diaphragm - the muscular sheet that separates your lungs and chest from your abdomen (see diagram above). But in some people, part of the stomach slides up into the chest cavity. This is called a hiatus hernia. It is quite common, but may cause pain, particularly heartburn.

You are most likely to get a hiatus hernia if during pregnancy or if you are overweight. If your symptoms are severe, your doctor may recommend that you have surgery to repair it.

Treatment

There are a few things you can do to reduce your symptoms of indigestion:

• cut down on fatty foods, tea, coffee and alcohol
• eat little and often
• stop smoking (see the separate Bupa health factsheet Giving up smoking)
• sleep in a more upright position, propped up on a pillow
• reduce your stress levels (see the separate Bupa health factsheet Stress)

Non-prescription medicines

You can buy a range of indigestion treatments from your pharmacist without a prescription (see 'Treatment' above).

Antacids

These neutralise acid, or help to stop the stomach contents flowing back (refluxing) into the oesophagus. They come as tablets, capsules, liquids or powders. Examples of antacid brands include Rennies and Gaviscon.

Some antacids contain an ingredient called an alginate which forms a barrier that floats on the top of the stomach contents to prevent them splashing back up into the oesophagus, preventing heartburn and reflux symptoms. Others contain magnesium or aluminium.

Many of the popular antacids brands contain a mixture of more than one active ingredient. Side-effects of antacids can include looseness of the bowels and constipation.

H₂ blockers

If antacids don't work, or if you need to take large quantities of antacid medicines to relieve your symptoms, your pharmacist may recommend a more powerful medication.

H₂ blockers work by reducing the amount of acid that the stomach produces. Examples of H₂ blockers are famotidine (eg Pepcid) and ranitidine (eg Zantac), and they come as tablets.

Prescription-only medicines

If your symptoms continue after taking antacids or H₂ blockers, your GP can prescribe another type of medicine called proton pump inhibitors. These work by stopping your stomach producing acid. Examples are omeprazole (Losec) and lansoprazole (Zoton).

Other medicines work by coating the stomach lining, to protect it from the acid. These include bismuth, sucralfate or carbenoxolone. However these are used less often than H₂ blockers and proton pump inhibitors.

If you have an H. pylori. infection, your GP may recommend having "triple therapy" to kill off the bacterial infection. This is usually a one-week course of a proton pump inhibitor combined with two different antibiotics.

Investigations

If lifestyle changes and drugs don't help, your doctor may recommend further tests, such as the ones listed below.

• Breath tests and blood tests are used to detect the presence of H. pylori.
• A barium meal X-ray is a test used to view your oesophagus, stomach and small intestines. Normal X-rays don't show these areas very well, but this test involves swallowing a drink containing barium, which shows up on an X-ray picture. This drink is a thick white liquid that is often fruit-flavoured. A series of X-rays are then taken - these show up problems such as ulcers, narrowing (known as strictures), hiatus hernias, reflux or cancer.
• Gastroscopy is an examination with a fibre-optic tube, with a light and lens on the end. For more information, please see the separate Bupa factsheet Gastroscopy. It is passed through the mouth down the oesophagus and into the stomach. The lens sends images that can be seen on a TV screen. A biopsy (a process that includes taking a small sample) of the stomach lining can be taken for laboratory analysis. This biopsy will show if you have H. pylori., inflammation of your stomach lining, or a cancer.

If these tests can't diagnose the problem, ultrasound, a CT or MRI scan or heart tests may be used to look at other organs such as your liver, heart, gall bladder, pancreas, bowels or kidneys.

Prevention

For heartburn symptoms that occur at night, it may help to sleep in a slightly more upright position, because the action of gravity reduces reflux.

To help prevent indigestion, the best advice is to eat regular meals and a balanced diet, so that you maintain a healthy weight. Don't smoke or drink alcohol in large amounts.

Further information

• Digestive Disorders Foundation
  020 7486 0341
  www.digestivedisorders.org.uk

Sources

1. Simon C, Everitt H, Birtwistle J, Stevenson B. Oxford Handbook of General Practice. Oxford: Oxford University Press, 2004.
2. Helicobacter pylori. The Helicobacter Foundation.
   www.helico.com/
   accessed 15 June 2006
3. Infectious agents and cancer: Helicobater pylori. Cancer Research UK.
   info.cancerresearchuk.org
   accessed 15 June 2006
4. Helicobacter pylori infection. Clinical Evidence.
   www.clinicalevidence.com
   accessed 15 June 2006
5. Gastro-intestinal system. British National Formulary 51, 2006: 37

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