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Indigestion

Introduction

What is indigestion?

Indigestion, also known as dyspepsia, is pain or discomfort, in your chest or stomach.  This usually comes on soon after eating or drinking. You may also have other symptoms such as:

  • feeling full or bloated
  • heartburn
  • nausea (feeling sick)
  • belching (burping)

Indigestion is a common problem that affects many people but in most cases it is mild and only occurs occasionally. Read more about the symptoms of indigestion.

Why it happens

Indigestion is caused by stomach acid coming into contact with the sensitive, protective lining (mucosa) of the digestive system. The stomach acid breaks down the lining, causing irritation and inflammation (soreness and swelling). This causes the symptoms of indigestion.

In most cases indigestion is related to eating, although it can be caused by other factors such as smoking, drinking alcohol or taking certain medications.

Read more about the causes of indigestion.

Treating indigestion at home

You may be able to treat your indigestion with changes to your diet and lifestyle, or with a number of different medications, such as antacids. Read more about the treatment of indigestion.

If an underlying health condition is the cause of indigestion, further investigation such as an endoscopy may be required (see below).

When to see your doctor

Most people will not need to seek medical advice for their indigestion. However, it is important to see your GP if you have recurring indigestion and you:

  • are 55 years old or over
  • have lost a lot of weight without meaning to
  • have increasing difficulty swallowing (dysphagia)
  • have persistent vomiting
  • have iron deficiency anaemia
  • have a lump in your stomach
  • have blood in your vomit or blood in your stools

This is because your symptoms can be a sign of an underlying condition affecting the digestive system, such as gastroesophageal reflux disease (GORD).

If this is the case, you may need to be referred for an endoscopy. An endoscopy is a procedure where the inside of the body is examined using an endoscope (a thin, flexible tube that has a light and camera on one end).

Severe indigestion can cause long-term problems with parts of your digestive tract, such as scarring of the oesophagus or the passage from your stomach. Read more about the possible complications of severe indigestion.

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Symptoms

The main symptom of indigestion (dyspepsia) is pain, or a feeling of discomfort, in your chest, or stomach. This usually comes on soon after eating, or drinking, but there can sometimes be a delay between eating a meal and having indigestion.

 Indigestion symptoms are often described as heartburn, which you may experience as a burning pain behind your breastbone (sternum). Heartburn is caused by acid that passes from your stomach into your oesophagus (gullet).

If you have indigestion, you may also have symptoms such as:

  • nausea (feeling sick)
  • belching (burping).
  • regurgitation (where food comes back up from your stomach)
  • bloating
  • nausea (feeling sick)
  • vomiting (being sick)

Serious symptoms

In some cases, indigestion can be a sign of a more serious underlying health problem, such as stomach cancer. Seek immediate medical attention if you have recurring indigestion and you:

  • are over the age of 55,
  • have lost a lot of weight without meaning to,
  • have increasing difficulty swallowing (dysphagia),
  • have persistent vomiting,
  • have iron deficiency anaemia, a reduction in the number of red blood cells because the body does not contain enough iron to produce them (which causes tiredness, breathlessness and an irregular heartbeat)
  • have a lump,  in your stomach.
  • have gastrointestinal bleeding, which is bleeding in your stomach and intestines (you may have blood in your vomit or stools and you may feel tired, breathless and dizzy)
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Causes

Indigestion (dyspepsia) can occur when acid from your stomach irritates the lining (mucosa) of your oesophagus (gullet), stomach, or duodenum (top part of your small intestine).

In most cases, there is no underlying medical reason for indigestion. It is usually caused by a process known as acid reflux, where acid from your stomach escapes and is forced back up into your oesophagus.

However, indigestion can also be caused in other ways, and it can sometimes be a symptom of an underlying medical condition,  particularly if you experience recurrent bouts. Some possible causes are explained below.

Medications

You may have indigestion if you take certain types of medication. Some medicines, such as nitrates (taken to widen your blood vessels) relax your lower oesophageal sphincter (the ring of muscle between your oesophagus and your stomach). This allows acid to leak back up.

Other medicines, such as non-steroidal anti-inflammatory drugs (NSAIDs), can affect your gastrointestinal tract (your stomach and intestines), causing indigestion.

Do not take NSAIDs, such as aspirin and ibuprofen, if you have stomach problems or have had them in the past, such as a peptic ulcer. Children under 16 years of age should not take aspirin.

See the Health A-Z topic about NSAIDs for more information about this type of medication.

Never stop taking a prescribed medication unless you are told to do so by your GP or another qualified healthcare professional who is responsible for your care.

Obesity

If you are obese (very overweight), you are more likely to experience indigestion. Being obese increases the pressure inside your abdomen (tummmy), which can force open the oesophageal sphincter after a large meal, causing stomach acid to escape and travel back up your oesophagus.

See the Encyclopaedia A-Z topic about Obesity for more information about this condition.

Hiatus hernia

A hernia occurs when an internal part of the body, such as an organ, pushes through a weakness in the surrounding muscle or tissue wall.

This type of hernia occurs when part of your stomach pushes up into your diaphragm (the breathing muscle under your lungs) and prevents the oesophageal sphincter from closing. This can allow stomach acid back up into your oesophagus, causing heartburn.

See the Encyclopaedia A-Z topic about Hiatus hernias for more information about this condition.

Helicobacter pylori infection

You may have recurring bouts of indigestion if you have an infection with bacteria known as Helicobacter pylori (H pylori). H pylori infections are common and it is possible to be infected without knowing it because it does not usually cause any symptoms.

However, in some cases, a H pylori infection can damage your stomach lining and increase the amount of acid in your stomach. It is also possible for your duodenum (top of your small intestine) to be irritated by excess stomach acid if you have a H pylori infection.

Gastroesophageal reflux disease (GORD)

This common condition is one of the main causes of recurring indigestion. It is caused by acid reflux, which occurs when the oesophageal sphincter fails to prevent stomach acid from coming back up into your oesophagus.

Acid reflux becomes GORD when the sensitive lining of your oesophagus is damaged by repeated irritation from stomach acid.

See the Encyclopaedia  A-Z topic about GORD for more information about this condition.

Peptic ulcers

If you have a peptic ulcer, you may have indigestion as a symptom. A peptic ulcer is the name given to an ulcer that appears in your stomach, or duodenum (top of your small intestine).

Peptic ulcers form as a result of stomach acid damaging the lining in your stomach, or duodenum wall. In most cases of peptic ulcers, this damage to the mucosa occurs due to an H pylori infection (see above).

See the Encyclopaedia A-Z topic about Peptic ulcers for more information about this condition.

Stomach cancer

In rare cases, recurrent bouts of indigestion can be a symptom of stomach cancer.

Cancer cells in your stomach break down the protective lining (mucosa) allowing acid to come into contact with your stomach wall.

Cancer Research UK estimates that around 7,700 cases of stomach cancer are diagnosed in the UK every year. There are 3 cases of stomach cancer for every 100 cancers that are diagnosed.

See the Encyclopaedia A-Z topic about Stomach cancer for more information about this condition.

 

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Diagnosis

For most people, indigestion (dyspepsia) is mild and infrequent, and does not require treatment from a healthcare professional. However, you should see your GP if you are experiencing indigestion regularly, or if it is causing you severe pain, or discomfort.

Your GP will ask you about your symptoms of indigestion as well as: 

  • any other symptoms you have, which may indicate an underlying health condition
  • any medication you are taking as some medications can cause indigestion
  • your lifestyle as some lifestyle factors can cause indigestion, such as smoking or drinking alcohol

Your GP may also examine your abdomen (tummy) by pressing gently on different areas to establish whether or not this is painful.

Depending on the type of indigestion symptoms you have, your GP may want to investigate your condition further. This is because indigestion can sometimes be a symptom of an underlying condition or health problem, such as a Helicobacter pylori (H pylori) infection.

Details of some of the further investigations you may have are outlined below.

Diagnosing anaemia

Your GP may also carry out a blood test if you have any symptoms of anaemia (a condition that is caused by a lack of red blood cells). The symptoms of anaemia can include:

  • tiredness,
  • breathlessness, and
  • an irregular heart beat.

Your GP will take a blood sample from a vein in your arm and carry out a full blood count (FBC). This means that all the different types of blood cells in the sample will be measured.

If you have anaemia, the blood test will indicate that you have a shortage of red blood cells (cells that carry oxygen) in your blood. A lack of red blood cells may be the result of gastrointestinal bleeding (internal bleeding into your stomach or intestines).

See the Encyclopaedia A-Z topic about Anaemia - diagnosis for more information about how the condition is diagnosed.

Endoscopy

An endoscopy is a procedure where the inside of your body is examined using an endoscope. An endoscope is a thin, flexible tube, about the width of your little finger, which has a light and a camera on one end. The camera is used to relay images of the inside of your body to a TV monitor.

An endoscopy is not often needed to diagnose indigestion, but your GP may suggest that you have one if:

  • they need to examine the inside of your abdomen in more detail
  • you have had treatment for indigestion that has not been effective
  • you have any serious symptoms (see Indigestion - symptoms)

Endoscopies are carried out in hospital. During the procedure, you will be awake but you may be given a sedative to help you relax. The surgeon will gently feed the endoscope down your throat and into your stomach. This will allow your surgeon to see images of the inside of your abdomen on a TV monitor.

See the Encyclopaedia  A-Z topic about Diagnostic endoscopy for more information about this procedure.

Taking certain medicines for indigestion can hide some of the problems that could otherwise be spotted during an endoscopy. For at least two weeks before your endoscopy, you will need to stop taking:

  • proton pump inhibitors (PPIs)
  • H2-receptor antagonists

Your GP may also recommend changing other medications that may be causing your indigestion. However, only stop taking medication if you are advised to do so by your GP or another healthcare professional responsible for your care. 

See Indigestion - treatment for more information about PPIs and H2-receptor antagonists.

Tests to diagnose Helicobacter pylori infection

If your GP thinks that your symptoms may be due to an infection with Helicobacter pylori (H pylori) bacteria, you may need to have several tests, such as: 

  • a urea breath test - you will be given a special drink containing a chemical that can be digested by the bacteria, and your breath will then tested for H pylori.
  • a stool antigen test - where a pea-sized stool sample (faeces) is tested for H pylori bacteria, or
  • a blood test - where a sample of your blood is tested for antibodies to H pylori bacteria. Antibodies are proteins that help fight infection.

Tests to diagnose other conditions

If your GP thinks that your indigestion symptoms may be caused by an underlying condition, you may need to have some other tests.

For example, abdominal pain and discomfort can also be caused by biliary conditions, which affect the bile ducts in your liver. The liver is the largest organ in your body and performs many functions, including storing energy and producing chemicals.

Your bile ducts are a series of tubes that carry bile (fluid used by the digestive system to break down fats) from the liver to the gallbladder (a pouch that holds bile) and the small intestine (part of the digestive system).

If your GP thinks that you may have a biliary condition, they may suggest that you have a liver function test, which is a kind of blood test that can be used to assess how well your liver is working.

You may also need to have an abdominal ultrasound. An ultrasound scan uses high-frequency sound waves to create an image of the inside of your body. See the Encyclopaedia A-Z topic about Ultrasounds for more information about this procedure.

 

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Treatment

Treatment for indigestion (dyspepsia) varies depending on what is causing your condition, and how severe your symptoms are.

If you have been diagnosed with an underlying health condition, see the Encyclopaedia  A-Z topics on Gastro-oesophageal reflux disease (GORD) and Peptic ulcer for more information on these conditions.

Diet and lifestyle changes

If you only have indigestion occasionally, with mild pain and discomfort, you may not need to visit your GP for treatment. You may be able to ease your symptoms by making a few simple changes to your diet and lifestyle. See the 'self help' section for more information about what you can do to relieve your indigestion.

Current Medication

Your GP may recommend making changes to your current medication if they think it could be contributing to your indigestion.

As long as it is safe to do so, you may need to stop taking certain medications, such as aspirin or ibuprofen. Where possible, your GP will prescribe an alternative medication that will not cause indigestion. However, never stop taking any medication without consulting your GP first.

Immediate indigestion relief

If you have indigestion that requires immediate relief, your GP can advise you about the best way to treat this. As well as lifestyle changes and reviewing your current medication, your GP may prescribe or recommend:

  • antacid medicines
  • alginates

These are described in more detail below.

Antacids

Antacids are a type of medicine that can provide immediate relief for mild to moderate symptoms of indigestion. They work by neutralising the acid in your stomach (making it less acidic), so that it no longer irritates the lining (mucosa) of your digestive system.

Antacids are available in tablet and liquid form. You can buy them over-the-counter (OTC) from pharmacies. Check with your pharmacist if you are unsure about which type of antacid is appropriate for you.

The effect of an antacid only lasts for a few hours at a time, so you may need to take more than one dose. However, you should always follow the instructions on the pack to ensure that you do not take too much.

It is best to take antacids when you are expecting symptoms of indigestion, or when they start to occur, such as after meals, or at bedtime. This is because antacids stay in your stomach for longer at these times and have more time to work. For example, if you take an antacid at the same time as eating a meal, it can work for up to three hours. In comparison, if you take an antacid on an empty stomach, it may only work for between 20-60 minutes.

You should not take antacids at the same time as other medicines because they can prevent other medicines from being properly absorbed by your body. For example, antacids can interfere with iron supplements. Speak to your GP to find out how much time you should allow between taking antacids and other medication. However, you should not stop taking any other medicines before first speaking to your GP.

You may find that antacids cause mild side effects, such as diarrhoea (passing loose, watery stools) or constipation ( an inability to empty your bowels). These side effects may be relieved by switching to an antacid that contains both magnesium salts and aluminium salts. Your pharmacist can give you advice about which antacid is suitable for you.

See the Encyclopaedia A-Z topic about Antacids for more information about this type of medication.

Alginates

Some antacids also contain a medicine called an alginate, which helps to relieve indigestion caused by acid reflux. Acid reflux occurs when stomach acid leaks back up into your oesophagus (gullet) and irritates its lining (mucosa). Alginates work by forming a foam barrier that floats on the surface of your stomach contents, keeping stomach acid in your stomach and away from your oesophagus.

Your GP may suggest that you take an antacid containing an alginate if you experience symptoms of acid reflux, or if you have gastroesophageal reflux disease (GORD). You should take antacids containing alginates after eating because this helps the medicine to stay in your stomach for longer. If you take alginates on an empty stomach they will leave your stomach too quickly to be effective.

Treating persistent indigestion

If you have indigestion that is persistent or recurring, your GP may prescribe a different type of medication. This will be prescribed at the lowest possible dose to control your symptoms. Possible medications include:

  • proton pump inhibitors
  • H2-receptor antagonists
  • prokinetics

These are described in more detail below. Your GP may also test you for the Helicobacter pylori (H pylori) bacteria (see Indigestion - diagnosis) and prescribe treatment for this if necessary.

Proton pump inhibitors (PPIs)

If your indigestion is severe, or recurring, treatment with antacids and alginates may not be effective enough to control your symptoms. If this is the case, your GP may prescribe proton pump inhibitors (PPI).

Like antacids, PPIs affect the acid in your stomach. However, rather than neutralising the acid, PPIs inhibit the acid production in your stomach.

PPIs are taken as tablets and are generally only available on prescription. However, if you are over 18 years of age, you can buy some types of PPIs over-the-counter (OTC) in pharmacies. However, these should only be used for short-term treatment. If your ingestion is persistent, see your GP.

PPIs may enhance the effect of certain medicines. If you are prescribed a PPI your progress will be monitored if you are also taking other medicines such as:

  • warfarin, a medicine that stops the blood clotting
  • phenytoin, a medicine to treat epilepsy

If your GP thinks that you should have an endoscopy (a procedure that allows a surgeon to see inside your abdomen) you will need to stop taking a PPI at least 14 days before the procedure. This is because PPIs can hide some of the problems that would otherwise be spotted during the endoscopy.

See Indigestion - diagnosis for more information about endoscopies.

In some cases, PPIs can cause side effects, but they are usually mild and reversible. These side effects may include:

  • headaches,
  • diarrhoea, or constipation,
  • nausea (feeling sick),
  • vomiting
  • flatulence (wind)
  • stomach pain,
  • dizziness,
  • skin rashes.

H2-receptor antagonists

H2-receptor antagonists are another medicine that your GP may suggest if antacids and alginates, and proton pump inhibitors (PPIs) have been ineffective in controlling your indigestion. There are four H2-receptor antagonists available:

  • cimetidine,
  • famotidine,
  • nizatidine, and
  • ranitidine.

They reduce the amount of acid in your stomach, thus making the stomach less acidic.

Your GP may prescribe any one of these four H2-receptor antagonist, although both famotidine and ranitidine are available to buy over-the-counter (OTC) in pharmacies. H2-receptor antagonists are taken either in tablet, or liquid, form.

Cimetidine can interact with a number of medications. It may not be suitable if you are taking certain medicines such as:

  • erythromycin (an antibiotic that is used to treat infections)
  • warfarin
  • phenytoin

As with proton pump inhibitors (PPIs) you will need to stop taking H2-receptor antagonists at least 14 days before having an endoscopy because they can hide some of the problems that could otherwise be spotted during the endoscopy.

Side effects of H2-receptor antagonists are uncommon but can include:

  • diarrhoea,
  • headaches,
  • dizziness,
  • skin rashes, and
  • tiredness.

Prokinetics (domperidone or metoclopramide)

If you are still experiencing symptoms of indigestion after taking both antacids and alginates, and proton pump inhibitors (PPIs), your GP may suggest a medicine known as a prokinetic.

There are two types of prokinetics available - domperidone and metoclopramide. They work by helping to make food pass through your stomach and the first part of your small intestine (duodenum) more quickly, so that indigestion is less likely to occur.

You may be prescribed domperidone by your GP, although it is also available over-the-counter (OTC) in pharmacies for those who are over 16 years of age. Metoclopramide is only available on prescription from your GP. Both medicines can be taken in tablet, or liquid, form.

If you are prescribed domperidone, you will need to take it 15-30 minutes before a meal so that it has time to work before your symptoms of indigestion start.

Treatment for an Helicobacter pylori (H pylori) infection

If your indigestion symptoms are caused by an infection with Helicobacter pylori (H pylori) bacteria, you will need to have treatment to clear the infection from your stomach. This should help to relieve your indigestion because the H pylori bacteria will no longer be increasing the amount of acid in your stomach.

H pylori infection is usually treated using triple therapy. Your GP will prescribe a course of treatment containing two different antibiotics (medicines to treat infections that are caused by bacteria)  and a proton pump inhibitor (a medication that inhibits acid production in your stomach) . You will need to take these medicines twice a day, for seven days. You must follow the dosage instructions closely to ensure that the triple therapy is effective.

In up to 85% of cases, one course of triple therapy is effective in clearing an H pylori infection. However, you may need to have more than one course of treatment if it does not clear the infection the first time.

 

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Self-help

For most mild cases of indigestion (dyspepsia), treatment from your GP is not needed and making certain changes to your diet and lifestyle can control your symptoms. Even if you are taking treatment for indigestion, making these changes may help to ease your symptoms and keep them from recurring.

Lose weight if you are overweight or obese

Being overweight, or obese, means that more pressure is put on your stomach, which makes it easier for stomach acid to be pushed up into your oesophagus (gullet). This is known as acid reflux, and is one of the most common causes of indigestion.

If you are overweight, or obese, it is important to lose weight safely and steadily through regular exercise and by eating a healthy, balanced diet.

See the Encyclopaedia A-Z topics about Obesity and Diet for more information.

Stop smoking

If you smoke, the chemicals that you inhale in cigarette smoke may be contributing to your indigestion. These chemicals can cause the ring of muscle (lower oesophageal sphincter) that separates your oesophagus (gullet) from your stomach to relax, allowing stomach acid to leak back up into your gullet more easily (acid reflux).

As well as helping to cause indigestion, smoking increases your risk of developing lung cancer, chronic obstructive pulmonary disease (COPD), chronic bronchitis (infection of the main airways of the lungs), emphysema (damage of the small airways of the lungs), as well as heart disease and stroke.

Diet and alcohol

You should avoid any food and drink that makes your indigestion symptoms worse. For example, you may find that your indigestion is made worse by certain triggers, such as:

  • drinking fruit juice
  • eating chocolate

Make a note of any particular food or drink that seems to make your indigestion worse and avoid them if possible. For example, this may mean eating less rich, spicy, and fatty foods, and cutting down on drinks that contain caffeine, such as tea, coffee, and cola.

You should also avoid drinking alcohol if it is aggravating your indigestion symptoms and making them worse.

At bedtime 

If you tend to experience indigestion symptoms at night, try to avoid eating or drinking anything for between 3-4 hours before you go to bed. Going to bed with a full stomach means that the acid in your stomach will be more likely to be forced up into your oesophagus (gullet) while you are lying down.

When you go to bed, use a couple of pillows to prop your head and shoulders up, or raise the head of your bed by a few inches by putting something underneath the mattress. The slight slope that is created should help to prevent stomach acid moving up into your oesophagus while you are asleep.

 

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Complications

In most cases, indigestion (dyspepsia) is mild and only occurs occasionally. However, severe indigestion can sometimes cause complications, some of which are outlined below.

Oesophageal stricture

Indigestion is often caused by acid reflux, which occurs when stomach acid leaks back up into your oesophagus (gullet) and irritates its lining (mucosa). If this irritation builds up over time, it can cause your oesophagus to become scarred. This scarring can eventually lead to your oesophagus becoming narrow and constricted (known as oesophageal stricture).

If you have oesophageal stricture, you may have symptoms such as difficulty swallowing, food becoming lodged in your throat, and chest pain. It is often treated using surgery to widen your oesophagus.

Pyloric stenosis

Like oesophageal stricture, pyloric stenosis is caused by long-term irritation of the lining of your digestive system from stomach acid. Pyloric stenosis occurs when the passage between your stomach and your small intestine (known as the pylorus) becomes scarred and narrowed. This causes vomiting and prevents any food you eat from being properly digested.

In most cases, pyloric stenosis is treated using surgery to return the pylorus to its proper width.

Peritonitis

Chronic (long-term) indigestion can break down and infect the lining of your intestinal tract (peritoneum), which is known as peritonitis. This usually occurs if there is a tear, or other damage to your peritoneum, which can be caused by repeated exposure to stomach acid.

Peritonitis can be treated using surgery to repair the damage to your peritoneum, and antibiotics may sometimes be used to clear the infection

See the Encyclopaedia A-Z topic about Peritonitis for more information about this condition.

 

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