When to worry about 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 food pipe (oesophagus), 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 adults and 1 in 5 in the US 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.

Pregnancy

Indigestion is common in pregnancy and around half of all pregnant women have indigestion at some point. Indigestion in pregnancy is usually due to reflux of acid from the stomach into the oesophagus.

Stomach cancer

Indigestion can occasionally be a sign of stomach cancer, although this is rare and most people who have indigestion do not have stomach cancer. If it gets worse or does not get better after 3 weeks with usual medicines it is recommended to see your doctor, particularly if combined with other symptoms such as unintended weight loss, feeling sick, and blood in your poo.

Medicines that cause indigestion

Medicines are a common cause of indigestion.

Some of the most likely to cause it include:

• Aspirin.

• Anti-inflammatory tablets - may be 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.

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.

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

• In heartburn, lying down often brings on the issue because the acid doesn't have to travel against gravity up into your food pipe. Propping the head of your 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 such as 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 discomfort. You could also try probiotics.