When to worry about indigestion

The medical term for indigestion is 'dyspepsia' - this includes several different types of stomach pain caused by problems with your digestive tract.

Symptoms of indigestion

Indigestion covers a variety of symptoms. The most common is pain - typically a burning pain in the top part of your stomach (upper abdomen), or travelling behind your breastbone. However, indigestion can also cause:

• Nausea or being sick.

• Bloating of your tummy.

• Burping.

• Feeling full quickly when you eat.

• Heartburn.

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Acid reflux and oesophagitis

When acid from the stomach leaks up into the oesophagus (tube carrying the food from the mouth to the stomach) the condition is known as acid reflux. This may cause heartburn and other symptoms. A medicine which reduces the amount of acid made in the stomach is a common treatment and usually works well. Some people take short courses of medication when symptoms flare up. Some people need long-term daily medication to keep symptoms away.

by Dr Pippa Vincent, MRCGP

How long can indigestion last?

In most cases, indigestion goes away in a few hours.

However, if you find you get indigestion often, or your symptoms last for more than two weeks¹, it could be a sign of a serious condition. In this case, it is important to talk to your doctor, as they may recommend tests to investigate the cause of your indigestion.

Causes of indigestion

Stomach acid

Indigestion is usually caused by inflammation in your stomach. This is often due to too much stomach acid, which your body makes to digest food. If this acid backs up into your gullet, it can cause heartburn - burning pain behind your breastbone, sometimes accompanied by a bitter liquid rising into your mouth. In the UK, 1 in 4 adults² and 1 in 5 in the US³ regularly experience heartburn.

Other causes include:

Ulcers

Peptic ulcers include ulcers in your stomach and the area connecting the top of your gut to your stomach (duodenum).

Hiatus hernia

Hiatus hernia occurs when the top part of the stomach pushes up into the chest cavity, often causing heartburn.

Medicines that cause indigestion

Medicines are a common cause of indigestion. Some of the most likely to cause it include:

• Aspirin.

• Anti-inflammatory tablets - maybe taken for muscle pains or arthritis. These include medicines such as ibuprofen, diclofenac and naproxen.

• Tablets taken daily, weekly or monthly to prevent osteoporosis, or 'thinning' of the bones (Bisphosphonates).

• Some antibiotics (especially erythromycin).

• Digoxin.

• Steroid tablets.

• Iron tablets.

• Medicines used for high blood pressure or sometimes angina (calcium antagonists).

If your indigestion starts, or becomes worse, shortly after you start taking one of these medicines, see your doctor. They may be able to change your tablets - or the time you take it - to stop indigestion from happening.

Germs

Sometimes a germ called Helicobacter pylori can make indigestion worse. Your doctor may perform a breath, poo (stool) or blood 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 alcohol for a week, but it can reduce the chance of symptoms returning.

How to treat indigestion

Proton pump inhibitors

Tablets like proton pump inhibitors (PPIs) - such as omeprazole, lansoprazole and, esomeprazole - help to keep stomach acid under control and hopefully ease the symptoms of indigestion.

Home remedies for indigestion

There are several home remedies that have proved to be effective in treating indigestion in the short-term.

These can include:

• Chamomile Tea⁴

• Peppermint Tea⁵

• Apple Cider Vinegar⁶

• Ginger⁷

• Fennel Seed⁸

However, home remedies should not be relied upon if your symptoms last for more than two weeks or worsen. 

If you have any pre-existing health conditions, you should also talk to your doctor before trying any of these.

When to see a doctor about indigestion

Indigestion and heartburn are rarely due to a serious cause, but there are some possible warning signs 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.

• Blood in your poo, especially if it's dark red and mixed in with the poo.

• Feel generally unwell - which can be down to anaemia - or tired.

• Persistent bloating that lasts for three weeks or longer - which could in rare cases be caused by ovarian cancer.

Further investigation

Your doctor may recommend further investigations for any of these reasons:

• If you have a past history of peptic ulcer.

• A condition called Barrett's oesophagus.

• If you develop persistent indigestion or reflux - especially with weight loss over the age of 55.

There are two main investigations to check what may be the cause of your long term indigestion:

• A gastroscopy - a small flexible tube is passed down your throat, sometimes under sedation, to look inside your stomach. This is done as a day case in hospital but you'll need someone to take you home afterwards.

• A colonoscopy - done where an abnormality of the lower bowel is suspected, You take medicines at home to empty your gut 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.

Preventing indigestion

There's much that you can do to relieve or prevent your symptoms happening the first place.

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 risers 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. You could also try probiotics.

Further reading

1. NIH: Symptoms and Causes of Indigestion

2. Imperial College Healthcare first NHS Trust: News

3. American College of Gastroenterology: Acid Reflux

4. Nyamwamu et al: A survey of medicinal plants used by the gusii community in the treatment of digestive disorders and other inflammatory conditions

5. Chumpitazi et al: The physiologic effects and safety of Peppermint Oil and its efficacy in irritable bowel syndrome and other functional disorders

6. Mesa et al: Effectiveness of Nutritional Ingredients on Upper Gastrointestinal Conditions and Symptoms: A Narrative Review

7. Aregawi et al: The Effect of Ginger Supplementation on the Improvement of Dyspeptic Symptoms in Patients With Functional Dyspepsia

8. Liu et al: Effects of dietary fennel (Foeniculum vulgare Mill.) seed powder supplementation on growth performance, nutrient digestibility, small intestinal morphology, and carcass traits of broilers