Indigestion

About indigestion

Indigestion is the name given to symptoms, such as pain or discomfort in your upper abdomen or chest, usually after eating a meal. Although indigestion is most common after meals, you can get it at any time and it can happen every day or once in a while. Nearly everyone will experience indigestion at some point in their life. It’s sometimes called dyspepsia.

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) that goes up to your neck.
  • Loss of appetite or being unable to finish meals.
  • Feeling sick.
  • Burping or belching.

Depending on the cause of your indigestion, your symptoms may range from mild to severe, 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 because you can usually manage them at home. However, if they get worse or don’t improve after two weeks, see your GP for advice.

Indigestion can be a symptom of a more serious condition. 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
  • black tarry stools that have an unusual smell
  • difficulty swallowing
  • frequent vomiting or blood in your vomit
  • shortness of breath and sweating

Causes of indigestion

Indigestion may be caused by inflammation of the layer of mucus that lines your stomach, oesophagus and bowel. The mucus is a protective barrier against gastric acid. It can become inflamed because of irritation caused by lifestyle triggers, such as:

  • drinking too much alcohol
  • smoking
  • stress and anxiety
  • medicines, such as aspirin and non-steroidal anti-inflammatory medicines (NSAIDs), used to treat arthritis
  • eating certain foods, such as spicy, fatty or greasy foods
  • being overweight or obese – this can increase the pressure on your stomach and contribute to feelings of indigestion

Underlying medical conditions

Some medical conditions can cause symptoms of indigestion.

Having a peptic ulcer can cause symptoms of indigestion. Peptic ulcers are breaks in the lining of your stomach or small bowel (duodenum) that occur because stomach acid that helps digest your food damages the lining. The bacteria called Helicobacter pylori that live in the mucus layer of your stomach can also contribute to the damage in your stomach lining by increasing acid production. However, not everybody infected with H. pylori will get a peptic ulcer.

Gastric cancer can also cause the symptoms of indigestion. Gastric cancer is a type of cancer that starts in the stomach.

Pregnancy

Many women suffer from indigestion during pregnancy. This may be triggered by changes to the levels of the female hormones progesterone and oestrogen. As your uterus (womb) grows, this may also cause symptoms of indigestion as it presses on your stomach.

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, blood tests or faecal (stool) 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. This test is also known as an endoscopy.
  • A barium swallow and meal X-ray – 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 foods that you think triggers your symptoms (it may help to keep a food diary to track what you eat and 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. They only work for a short time so you will need to take them frequently.

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 receptor antagonists (H2RAs). These work by reducing the amount of acid that your stomach produces. They work for longer than antacids but not as quickly. Examples of H2RAs are famotidine and ranitidine.

If your symptoms continue after taking antacids or H2RAs 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 reducing your stomach acid. You can take an over-the-counter proton pump inhibitor for a maximum of four weeks.

Prescription-only medicines
If a proton pump inhibitor is controlling your symptoms, your GP may prescribe you one for long-term use if he or she thinks it’s appropriate. Your GP may suggest diet and lifestyle changes, such as losing weight, first.

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.

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 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.

Talking therapies

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

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, or because your growing uterus (womb) presses against your stomach. This can increase your chance of acid reflux.

Explanation

Between four and eight in every 10 women in the UK are thought to suffer from indigestion during pregnancy. The main symptoms of indigestion include the following.

  • Pain, fullness or discomfort in your chest or the upper part of your abdomen (tummy).
  • A burning feeling (heartburn) that goes up to your neck.
  • Loss of appetite or unable to finish meals.
  • Feeling sick.
  • Burping or belching.

Symptoms of indigestion may start at any time during your pregnancy and you’re more likely to get them when you’re pregnant if you had indigestion either before you were pregnant or during a previous pregnancy. Symptoms usually occur more frequently as your pregnancy progresses.

If you get indigestion when you’re pregnant, it will most likely last for the whole of your pregnancy. Your symptoms should improve very quickly after your baby is born, once your hormones return to the levels they were at before you became pregnant.

It’s important that you contact your GP for advice if you’re pregnant and develop indigestion. He or she will want to rule out any other causes of your symptoms.

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 (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 swallowing which means that some of your stomach contents can come back into your oesophagus.

It’s not clear why the valve that joins your oesophagus and stomach stops working. Some lifestyle factors are thought to aggravate the condition, for example, having a very full stomach, being overweight, smoking or eating certain foods, such as alcohol, caffeine, chocolate and fatty foods.

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 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. Keeping a diary of what you have eaten and when you get heartburn can help you to identify if a food is causing the problem. You can then avoid eating that food to find out if your symptoms improve.

Cutting down on how much alcohol you drink, stopping smoking and losing any excess body weight can also help ease symptoms of GORD. Eating smaller meals and eating your evening meal three to four hours before going to bed may also help.

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. Making some changes to your diet can 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 stopping smoking, reducing your stress levels and eating and drinking more slowly can help relieve your symptoms. Gas is also produced in your bowel when food you’ve eaten is broken down to be absorbed. This gas passes out through your rectum as flatulence.

Reducing the amount of fizzy drinks you drink can help as they cause your stomach to produce more gas. Certain foods, such as beans and cabbage, can also increase the amount of 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 cow's, goat's and sheep's 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 aren't reduced by changes to your diet, or if they worsen, contact your GP for advice.