Tummy troubles: when to worry about indigestion
Most of us get indigestion from time to time. It may be an occasional problem due to overindulgence, perhaps after a large or spicy meal. But for some, it’s a major headache. How can you avoid it, and when should you worry?
If you thought indigestion was the one condition where smoking didn’t matter, think again! Smoking can worsen indigestion and heartburn Treatment is all based on reducing acid levels in your stomach – antacids work fast but only last for a few hours.
The medical term for indigestion is ‘dyspepsia’ – this is an umbrella term which includes several different types of tummy pain caused by problems with your digestive tract. Peptic ulcers include ulcers in your stomach and the duodenum – the first part of the gut after your stomach. Gastritis and duodenitis are the terms used for inflammation of the stomach and duodenum without an ulcer. Hiatus hernia occurs when the top part of the stomach pushes up into the chest cavity, and it often causes heartburn. ‘Functional’ dyspepsia is indigestion with no obvious abnormality of the gut wall, such as inflammation, ulcer or hiatus hernia.
The most common symptom of gastritis, ulcers and functional dyspepsia is a burning pain in the top centre of your tummy, just under the ribcage. It can cause wind, bloating, feeling or being sick and getting full quickly on eating.
In the UK, one in three adults suffer from heartburn and one in six get it at least twice a week. It’s caused by acid from your stomach (where it’s used to digest food) into your gullet and sometimes your throat. Hence the symptoms of burning behind your breastbone and an acid taste at the back of the mouth.
We’ve come a long way in the treatment of indigestion, heartburn and peptic ulcers, and it’s all down to advances in medicines. When I was a medical student, it was fairly common for people to need surgery to control their symptoms – these days tablets like PPIs (their names all end in ‘-azole’ – omeprazole, lansoprazole, esomeprazole etc) keep acid under control much better.
Sometimes a germ called H. Pylori can make indigestion worse . Your doctor may test for this and, if necessary give you a one-week course of treatment with three different tablets to get rid of it. This doesn’t always work, and it involves taking several tablets a day and often having to avoid even a sip of alcohol for a week, but it can greatly reduce the chance of symptoms returning.
Indigestion and heartburn are rarely due to a serious cause, but there are some ‘red flags’ which should be checked out by a doctor. They include:
- Severe pain which doesn’t settle with remedies from your pharmacist or doctor
- Being off your food or losing weight for no obvious reason
- Food sticking when you swallow, or severe pain on swallowing
- Vomiting up blood or black ‘coffee grounds’
- Blood in your poo, especially if it’s dark red and mixed in with the poo (rather than being on the paper or in the pan) or passing black, tarry poos
- Feel generally unwell (which can be down to anaemia) or tired.
If you get any of these symptoms, if you have a past history of peptic ulcer or a condition called Barrett’s oesophagus, or if you develop persistent indigestion or reflux (especially with weight loss) over the age of 55, your doctor may recommend further investigations.
There are two main investigations. One is a gastroscopy – a small flexible tube is passed down your throat, sometimes under sedation, to look inside your tummy. This is done as a day case in hospital but you’ll need someone to take you home afterwards. The other, done where an abnormality of the lower bowel is suspected, is a colonoscopy. You take medicines at home to empty your bowels completely, then go in as a day case to hospital and have a small flexible tube passed up from your bottom to examine your large bowel.
There’s much that you can do to relieve or prevent your symptoms. In heartburn, lying down often brings on the problem because the acid doesn’t have to travel against gravity up into your gullet. Propping the head of the bed up on a couple of bricks may help. So too can losing weight, avoiding tight belts or trousers and staying away from large meals or eating too close to bedtime. For other indigestion, you may find that some foods like peppermint, tomatoes, alcohol or spicy foods are best avoided. Your pharmacist can advise on short-term remedies or a course of tablets to relieve the misery.
With thanks to ‘My Weekly’ magazine where this article was originally published.