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 regular annoyance. How can you avoid it, and when should you worry?
The medical term for indigestion is 'dyspepsia' - this includes several different types of abdominal pain caused by problems with your digestive tract.
Symptoms of indigestion
Indigestion covers a multitude of symptoms. The most common is pain - typically a burning pain in your upper abdomen, or travelling behind your breastbone. However, indigestion can also cause:
- Nausea or being sick.
- Bloating of your tummy.
- Feeling full quickly when you eat.
Causes of indigestion
Indigestion is usually caused by inflammation in your stomach. This is often due to an excess of stomach acid, which your body produces to digest food. If this acid refluxes 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, one in three adults suffer from heartburn and one in six get it at least twice a week.
Other causes include:
Peptic ulcers include ulcers in your stomach and the duodenum - the first part of the gut after your stomach.
Hiatus hernia occurs when the top part of the stomach pushes up into the chest cavity, and it often causes heartburn.
Medicines are a common cause of indigestion. Some of the most likely culprits include:
- Anti-inflammatory tablets (taken for muscle pains, arthritis, etc - they include medicines like ibuprofen, diclofenac and naproxen).
- Bisphosphonates (tablets taken daily, weekly or monthly to prevent osteoporosis, or 'thinning' of the bones).
- Some antibiotics (especially erythromycin).
- Steroid tablets.
- Iron tablets.
- Calcium antagonists (used for high blood pressure or sometimes angina).
If your indigestion starts, or becomes worse, shortly after you start taking one of these medicines, see your GP. They may be able to change your tablet - or the time you take it - to stop indigestion from occurring.
Medicines that can help
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 Helicobacter pylori can make indigestion worse. Your doctor may perform a breath, 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 even a sip of alcohol for a week, but it can greatly reduce the chance of symptoms returning.
When to worry
Indigestion and heartburn are rarely due to a serious cause, but there are some 'red flags' or 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.
- 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.
- Persistent bloating that lasts for three weeks or longer (which could in rare cases be caused by ovarian cancer).
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 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 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. It's worth reading our article on probiotics too, to see if they might be worth trying.