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Indigestion

Published by Bupa's health information team, September 2008.

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. Sometimes it's also used to describe a distinctive burning feeling in the chest, which is also known as heartburn.

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. Most people have suffered from indigestion after a large meal at some time, and up to four in 10 adults suffer from heartburn each year. Although it's most common after meals, you can get indigestion at any time.

Illustration showing the digestive system
The digestive system

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

Indigestion has several causes. Depending on what's causing your indigestion, your symptoms may go very quickly, come and go, or they may be regular and last a long time.

The symptoms of indigestion may sometimes be caused by a serious underlying condition.

You should visit your GP for advice if you have:

  • unintended weight loss
  • unexplained and continual indigestion symptoms for the first time and you are aged 55 or older
  • severe pain, or the pain gets worse or changes

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

Causes of indigestion

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

Some of the following can trigger symptoms of indigestion:

  • drinking excess alcohol
  • smoking
  • stress and anxiety
  • medicines such as aspirin and anti-inflammatory medicines used to treat arthritis
  • eating certain foods can relax the valve (sphincter) at the join between your oesophagus and stomach or cause direct irritation to the lining of your oesophagus
  • not eating regular meals, as acid levels can build up if meals are missed

Heartburn

Heartburn is a burning pain caused by the stomach acid flowing back up your oesophagus. This is called reflux. The medical term for the condition is gastro-oesophageal reflux disease (GORD).

With heartburn, the sphincter at the top of your stomach doesn't work properly, allowing reflux of the stomach acid.

Peptic ulcers

These are stomach (gastric) or duodenal ulcers which occur when either the lining of your stomach or your duodenum is damaged and becomes inflamed.

Helicobacter pylori (H. pylori)

This is a bacterium that lives in the mucous layer of your stomach and can cause irritation (gastritis). Most people acquire infection with these bacteria in early childhood and often it doesn't cause any problems (they just 'carry' the bacteria).

In the UK, more than half of people aged 50 or over carry H. pylori, and some of these people will go on to develop a peptic ulcer. H. pylori is thought to play a part in causing these stomach ulcers. A small proportion of people who carry H. pylori may develop stomach cancer.

If H. pylori is detected, it can be treated with a course of tablets taken for seven days (see Treatment).

Hiatus hernia

Usually your stomach is completely below your diaphragm (the sheet of muscle that separates your lungs and chest from your abdomen). But in some people, part of the stomach or the sphincter can slide up into the chest cavity. This is called a hiatus hernia. It's quite common, but in some people it may cause heartburn due to reflux of stomach acid.

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 it.

Pregnancy

Many women suffer from indigestion during pregnancy. One reason for this is the baby increases pressure against your stomach. This can then increase the chance of reflux.

Cancer

Cancer can also trigger symptoms of indigestion, but this is rare.

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, your GP may recommend further tests, such as the ones listed below.

  • Breath tests or blood tests to detect the presence of H. pylori.
  • A gastroscopy is a procedure used to look inside the oesophagus, stomach and the first part of the small intestine (duodenum). During the gastroscopy you may have a biopsy which is a small sample of tissue. This will be sent to a laboratory for testing.
  • A barium meal X-ray is a test that involves swallowing a drink containing barium (a substance which shows up on X-rays). X-ray images of your abdomen then show the inside of your bowel more clearly.

If these tests can't diagnose the problem, the following may be used to look at other organs such as your liver, heart, gallbladder, pancreas, bowels or kidneys.

  • An ultrasound uses sound waves to produce an image of the inside of your body or part of the body.
  • A CT scan uses X-rays to make a three-dimensional image of the body or part of the body.
  • An MRI scan uses magnets and radiowaves to produce images of the inside of your body.
  • An electrocardiogram (ECG) is a test that measures the electrical activity of your heart to see how well it's working.
  • Blood tests can help your doctor to check your general health. Your blood may also be tested to see whether it contains particular chemicals (markers), which are sometimes produced by cancer cells.

Treatment of indigestion

Self-help

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

  • cutting down on fatty foods, tea, coffee and alcohol
  • 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 bed if you have a peptic ulcer
  • reducing your stress levels
  • not overeating, or eating too quickly

Medicines

Non-prescription medicines

You can buy a range of indigestion treatments 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 often relieve symptoms of indigestion by neutralising acid in your stomach. They usually contain magnesium or aluminium. Some antacids contain an ingredient called an alginate which forms a barrier that floats on the top of your stomach contents to prevent reflux.

Examples of antacid brands include Rennie and Mucogel, and many of the popular antacid brands contain a mixture of more than one active ingredient. 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 (eg Pepcid) and ranitidine (eg Zantac).

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 (eg Losec) and lansoprazole (eg Zoton).

Other medicines work by coating your stomach lining to protect it from the acid. These include bismuth (eg De-Noltab) and sucralfate (eg Antepsin). 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 course of a proton pump inhibitor combined with two different antibiotics, taken for seven days.

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

Complementary therapies

Some people may find that talking therapies, such as cognitive behavioural therapy (CBT) and psychotherapy may reduce the symptoms of indigestion. These types of treatments can be expensive, and aren't usually provided on the NHS.

Further information

Related topics

Sources

  • Warrell DA, Cox TM, Firth JD, Benz EJ. Oxford Textbook of Medicine. 4th ed. Vol 2. Oxford: Oxford University Press, 2005
  • Dyspepsia. A national clinical guidance. Scottish Intercollegiate Guidelines Network (SIGN), 2003. www.sign.ac.uk
  • Information about indigestion. CORE digestive disorders. www.digestivedisorders.org.uk, accessed 3 March 2008
  • Dyspepsia. Management of dyspepsia in adults in primary care. National Institute for Health and Clinical Excellence (NICE), 2005, Clinical Guideline 17. www.nice.org.uk
  • What is Helicobacter pylori? The Health Protection Agency. www.hpa.org.uk, accessed 3 March 2008
  • Dyspepsia - pregnancy-associated. Clinical Knowledge Summaries. www.cks.library.nhs.uk, accessed 10 March 2008
  • Simon C, Everitt H, Kendrick T. Oxford Handbook of General Practice. 2nd ed. Oxford: Oxford University Press, 2007
  • Joint Formulary Committee, British National Formulary. 54th ed. London: British Medical Association and Royal Pharmaceutical Society of Great Britain, 2007.

This information was published by Bupa's health information team and is based on reputable sources of medical evidence. It has been peer reviewed by Bupa doctors. The content is intended for general information only and does not replace the need for personal advice from a qualified health professional.

Publication date: September 2008

 

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