Indigestion

Introduction

Most of us have suffered the uncomfortable symptoms of indigestion. Understanding what causes indigestion may help you avoid it and improve your digestive health as well.

What is indigestion?

Indigestion isn't actually a condition, it's a collection of symptoms that can cause anything from mild discomfort to such severe pain that it can be mistaken for a heart attack. (The reverse is true, also. There are cases where someone having a heart attack can mistake it for indigestion, so it's important to know the symptoms of both).

Some of us are rarely troubled by indigestion, for others it is a painful, and frequent, part of their daily life. The chief symptom of indigestion (also known as dyspepsia) is pain or discomfort of varying degrees in your upper abdomen a burning feeling in the chest just behind the breastbone that occurs after eating and lasts from between a few minutes to several hours.

Other symptoms can include:

• Heartburn (stomach acid reflux)
• Wind (burping or passing wind)
• Feeling bloated
• Losing your appetite
• Feeling full very quickly when you've eaten

Heartburn is where acid from your stomach comes up into your gullet (oesophagus). This is known as acid reflux and can happen if the muscle - known as a sphincter - between your stomach and oesophagus which opens to allow food down, is not working properly and it allows the contents of your stomach to come back up.

Heartburn is the major symptom of gastro-oesophageal reflux disease (GORD), a disease in which stomach acid or, occasionally, bile, flows back (refluxes) into your food pipe (oesophagus). As GORD may also be caused by bile reflux, the term "acid reflux disease" more specifically describes the disease, but doesn't describe the body part affected. 

Why do I get indigestion?

Bouts of indigestion are mostly caused by what you've eaten, and to some extent, how you have eaten it.

You are more likely to suffer indigestion, if you have eaten a particularly large meal, or spicy and fatty foods. It can also be triggered by tomatoes, coffee, chocolate, oranges and smoking.

How and when you eat can also contribute to your discomfort. Slumping or hunching over your food can cause indigestion, as can not eating often enough. When you eat, the food decreases the acidity levels in your stomach. Leave it too long between meals and the acidity levels will build up.

Other reasons for indigestion

Some medical conditions can cause indigestion: hiatus hernia, duodenal and stomach ulcers (also known as peptic ulcers), and gastritis (when your stomach becomes inflamed).

In addition, nocturnal indigestion or heartburn can be severe enough to wake you up in the night, with choking, coughing and wheezing. Some studies have shown that nocturnal heartburn and acid regurgitation are associated with more severe GORD symptoms.

Although a direct link between stress and heartburn remains unproven, stress can lead to behaviours that may trigger heartburn, such as increased intake of alcohol, eating the wrong kinds of foods too quickly and smoking. When we are stressed, our routines can be disrupted. People under stress also are likely to be more aware of heartburn symptoms, where in the past they might have been able to ignore the heartburn.

Forty per cent of us in the UK have the bacteria helicobacter pylori (H pylori) living in our stomachs. In many cases no symptoms occur, but the bacterium can cause peptic ulcers. Some medicines, particularly anti-inflammatory drugs, such as ibuprofen and aspirin, can cause peptic ulcers if used often.

If you have heartburn often, you may have gastro-oesophageal reflux disease (GORD). Tell your GP about your symptoms. They will suggest the most appropriate treatment for your situation. Indigestion can also be one of the symptoms of stomach cancer, however this is quite unusual.

What's the treatment for indigestion?

Treatment for Indigestion really depends on how bad it is and how often you've had it. In many cases you can treat indigestion with medicines bought from your local pharmacy, such as antacids, which reduce the acidity of your stomach acid.

You could also try alginate drugs which float on the surface of the stomach contents and provide a physical barrier to gastro-oesophageal reflux. Frequently, these are found in preparations combined with an antacid, for example the over-the-counter treatments Acidex ®, Gastrocote ® and Rennie Duo ®.

H2 antagonists, such as cimetidine, famotidine, nizatidine and ranitidine are another type of drug that may help in the short term.

Always ask your pharmacist for advice before buying over-the-counter (OTC) medicines for indigestion.

There are some symptoms you should see your GP about:

• If you are suffering from indigestion  but have also lost weight recently, yet have not been dieting
• If you have indigestion with a lot of pain, or if you are over 45 and having indigestion for the first time
• If you vomit blood, or a dark, grainy substance that looks like ground-up coffee beans, you need medical treatment immediately

If self-help measures don't work, or if your symptoms are getting worse, talk to your GP. Your doctor may prescribe Proton Pump Inhibitor (PPIs) drugs, such as omeprazole, esomeprazole, lansoprazole, pantoprazole and rabeprazole,which reduce the production of stomach acid.

Your GP may also refer you for tests to check for underlying conditions, such as a stomach ulcer. These could include an endoscopy, which allows doctors to look inside your stomach. In some cases, for instance, if you have a stomach ulcer that is bleeding, you may need surgery.

There are some symptoms you should see your GP about:

• If you are suffering from indigestion  but have also lost weight recently, yet have not been dieting
• If you have indigestion with a lot of pain, or if you are over 45 and having indigestion for the first time
• If you vomit blood, or a dark, grainy substance that looks like ground-up coffee beans, you need medical treatment immediately

If self-help measures don't work, or if your symptoms are getting worse, talk to your GP. Your doctor may prescribe Proton Pump Inhibitor (PPIs) drugs, such as omeprazole, esomeprazole, lansoprazole, pantoprazole and rabeprazole,which reduce the production of stomach acid.

Your GP may also refer you for tests to check for underlying conditions, such as a stomach ulcer. These could include an endoscopy, which allows doctors to look inside your stomach. In some cases, for instance, if you have a stomach ulcer that is bleeding, you may need surgery.

How can I avoid indigestion?

Making a note of when you have indigestion and what you had eaten. This may help you identify foods or situations that trigger the problem. Avoid eating large, spicy or fatty meals and don't eat too late in the evening.

Bending forward, lying down or even wearing over-tight clothes can be a trigger after a big meal. Try eating smaller amounts but more often, and sleeping slightly propped up can help.

Drink only moderate amounts of alcohol and stop smoking - this will be good for your health in all sorts of ways.

Clickthrough information and support links:

CORE - Digestive Disorders Foundation