Indigestion (Dyspepsia)
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.
Indigestion is a common problem that affects many
people, but in most cases it is mild and only occurs occasionally.
Indigestion can be really troublesome.
Why it happens
Indigestion is caused by stomach acid coming into
contact with the sensitive, protective lining of the digestive system. The
stomach acid breaks down the lining, leading to 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,
pregnancy or taking certain medications.
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. If an underlying health condition is the cause of
indigestion, further investigation such as an endoscopy may be required.
Most people will not need to seek medical advice
for their indigestion. However, it is important to see your family doctor 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.
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Indigestion can give you a "burning" feeling in the epigastriu, the area above the umbilicus.
This is because your symptoms can be a sign of an
underlying health condition that affects the digestive system, such as
gastro-oesophageal 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.
Causes of
indigestion
Indigestion (dyspepsia) occurs when acid from your
stomach irritates the lining of your stomach, oesophagus (gullet) and top part
of your bowel. 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.
You may have indigestion if you take certain types
of medication. Some medicines, such as nitrates (taken to widen your blood
vessels) relax the oesophageal sphincter (ring of muscle between your
oesophagus and your stomach), which allows acid to leak back up. Other medicines, such as non-steroidal
anti-inflammatory drugs (NSAIDs), can affect your digestive tract and
cause indigestion.
Do not take NSAIDs, such as aspirin and
ibuprofen, if you have stomach problems such as a peptic ulcer or have had this
in the past. Children under 16 years of age should not take aspirin. Never stop taking a prescribed medication unless
you are told to do so by your doctor or another qualified healthcare professional
who is responsible for your care.
If you are very overweight, you are more likely to
experience indigestion because of increased pressure inside your abdomen
(tummy). This can force open your oesophageal sphincter after a large meal, causing
acid reflux.
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. A hiatus hernia occurs when part of your
stomach pushes up into your diaphragm (the sheet of muscle under your lungs),
preventing your oesophageal sphincter from closing. This can allow stomach acid
to travel back up into your oesophagus, leading to heartburn.
You may have recurring bouts of indigestion if you
have an infection with Helicobacter pylori (H pylori) bacteria. H pylori
infections are common, and it is possible to become infected without realising
because the infection does not usually cause any symptoms. However, in some cases an H pylori infection can
damage your stomach lining and increase the amount of acid in your stomach. It
is also possible for your duodenum (the top of your small intestine) to be
irritated by excess stomach acid if you have an H pylori infection.
Gastro-oesophageal reflux disease (GORD) is a
common condition and one of the main causes of recurring indigestion. It is
caused by acid reflux. This occurs when the oesophageal sphincter fails to prevent
stomach acid from moving back up into your oesophagus. Acid reflux becomes GORD when the sensitive lining
of your oesophagus is damaged by repeated irritation from stomach acid.
A peptic ulcer is an open sore that develops
on the inside lining of your stomach (a gastric ulcer) or small intestine (a
duodenal ulcer). If you have a peptic ulcer, you may have indigestion as a
symptom. Peptic ulcers form when stomach acid damages
the lining in your stomach or duodenum wall. In most peptic ulcer cases, the
lining is damaged as a result of an H pylori infection (see above).
In rare cases, recurrent bouts of indigestion can
be a symptom of stomach cancer. Cancer cells in your stomach break down the
protective lining, allowing acid to come into contact with your stomach wall.
Diagnosing
indigestion
For most people, indigestion (dyspepsia) is mild
and infrequent and does not require treatment from a healthcare professional. However, see your doctor if you have indigestion
regularly or if it causes you severe pain or discomfort. Your doctor will ask about your indigestion symptoms 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, such as smoking or drinking alcohol, can
cause indigestion).
Your doctor may also press gently on different
areas of your tummy to establish whether or not this is painful. Depending on the type of indigestion symptoms you
have, your doctor 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) bacterial infection.
You may be referred to hospital to have an
endoscopy. An endoscopy is a procedure to examine the inside
of your body using an endoscope - a thin, flexible tube, about the width of
your little finger, with 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 doctor 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 of
indigestion.
Taking certain medicines for indigestion can hide
some of the problems that could otherwise be spotted during an endoscopy.
Therefore, for at least two weeks before your endoscopy, you will need to stop
taking proton pump inhibitors (PPIs) and H2-receptor antagonists.
Your doctor 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 doctor or another healthcare
professional responsible for your care.
If your doctor thinks that your symptoms may be due to
an infection with 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: a pea-sized stool
(faeces) sample will be tested for H pylori bacteria
- a blood test: a blood sample will be tested
for antibodies to H pylori bacteria (antibodies are proteins produced by
the body to fight infection).
Antibiotics and PPIs can affect the results of a
urea breath test or a stool antigen test. Therefore, these tests may need to be
delayed until two weeks after you last used a PPI, and four weeks after you
last used an antibiotic.
If your doctor believes thinks that your indigestion symptoms
may be caused by another underlying medical condition, you may need to have
some further tests to rule this out. For example, abdominal pain and discomfort can also
be caused by conditions affecting the bile ducts in your liver. 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 bowel. If your doctor thinks that you may have such a condition, they may
suggest you have a liver function test, which is a type of blood test used to
assess how well your liver is working.
You may also need to have an abdominal ultrasound.
An ultrasound scan scan uses high-frequency sound waves to create an
image of the inside of your body.
Complications
of indigestion
In most cases, indigestion (dyspepsia) is mild and
only occurs occasionally. However, severe indigestion can cause complications,
some of which are outlined below.
Indigestion is often caused by acid reflux, which
occurs when stomach acid leaks back up into your oesophagus (gullet) and
irritates its lining. If this irritation builds up over time, it can cause your
oesophagus to become scarred. The 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 (dysphagia)
- food that becomes lodged in your throat
- chest pain.
Oesophageal stricture is often treated using
surgery to widen your oesophagus.
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.
Repeated episodes of acid reflux can lead to
changes in the cells of the lining of your lower oesophagus. This is a
condition known as Barrett’s oesophagus. Barrett’s oesophagus does not usually cause any
noticeable symptoms other than those associated with acid reflux. However,
there is a small risk that the cells affected by Barrett’s oesophagus could
turn cancerous and trigger oesophageal cancer.
Treating
indigestion
Treatment for indigestion (dyspepsia) will vary
depending on what is causing it and how severe your symptoms are. If you have been diagnosed with an underlying
health condition, you may want to read our information on treating
gastro-oesophageal reflux disease (GORD) and treating a peptic ulcer.
If you have indigestion only occasionally with mild
pain and discomfort, you may not need to see your doctor for treatment. It may be
possible to ease your symptoms by making a few simple changes to your diet and
lifestyle.
Being overweight puts more pressure on your
stomach, making it easier for stomach acid to be pushed back 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.
If you smoke, the chemicals you inhale in cigarette
smoke may contribute to your indigestion. These chemicals can cause the ring of
muscle that separates your oesophagus (gullet) from your stomach to relax. This
allows stomach acid to leak back up into your oesophagus more easily (acid
reflux).
Make a note of any particular food or drink that
seems to make your indigestion worse and avoid these if possible. This may
mean:
- eating less rich, spicy and fatty foods
- cutting down on drinks that contain caffeine,
such as tea, coffee and cola
- avoiding or cutting down on alcohol.
If you tend to experience indigestion symptoms at
night, avoid eating for three to four hours before you go to bed. Going to bed
with a full stomach means there is an increased risk that acid in your stomach
will be forced up into your oesophagus 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.
Your doctor 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 doctor will prescribe an alternative medication that will not cause
indigestion. However, never stop taking any medication without consulting your doctor first.
If you have indigestion that requires immediate
relief, your doctor can advise you about the best way to treat this. As well as
lifestyle changes and reviewing your current medication, your doctor may prescribe
or recommend:
- antacid medicines
- alginates.
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 of your digestive system. Antacids are available in tablet and liquid form.
You can buy them over the counter from most pharmacies without a prescription.
The effect of an antacid only lasts for a few hours
at a time, so you may need to take more than one dose. Always follow the
instructions on the packet to ensure 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
- 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
20 to 60 minutes.
Some antacids also contain a medicine called
an alginate. This helps relieve indigestion caused by acid reflux. Acid reflux occurs when stomach acid leaks back up
into your oesophagus and irritates its lining. Alginates form a foam
barrier that floats on the surface of your stomach contents, keeping stomach
acid in your stomach and away from your oesophagus.
Your doctor may suggest that you take an antacid that
contains an alginate if you experience symptoms of acid reflux or if you have
gastro-oesophageal reflux disease (GORD). Take antacids containing alginates after eating,
because this helps the medicine stay in your stomach for longer. If you take
alginates on an empty stomach, they will leave your stomach too quickly to be
effective.
If you have indigestion that is persistent or
recurring, treatment with antacids and alginates may not be effective enough to
control your symptoms. Your doctor may prescribe a different type of medication,
which 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 doctor may also test you for the Helicobacter pylori (H pylori) bacteria, and
prescribe treatment for this if necessary.
PPIs inhibit the acid produced in your stomach. The medication is taken as tablets and is
generally only available with a prescription. If you are over 18, you can buy
some types of PPIs over the counter in pharmacies, but these should only be
used for short-term treatment. If your ingestion is persistent, you must see your doctor.
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 doctor refers you for 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. In some cases, PPIs can cause side effects.
However, they are usually mild and reversible. These side effects may include:
- headaches
- diarrhoea
- constipation
- nausea (feeling sick)
- vomiting
- flatulence (wind)
- stomach pain
- dizziness
- skin rashes.
H2-receptor antagonists are another type of
medication that your doctor may suggest if antacids, alginates and PPIs have not
been effective in controlling your indigestion. There are four H2-receptor
antagonists:
- cimetidine
- famotidine
- nizatidine
- ranitidine.
These medicines work by lowering the acidity level
in your stomach. Your doctor may prescribe any one of these four
H2-receptor antagonists, although famotidine and ranitidine are available to
buy over the counter in pharmacies. H2-receptor antagonists are taken either in
tablet or liquid form.
As with PPIs, you will need to stop taking
H2-receptor antagonists at least 14 days before having an endoscopy. This
is because they can hide some of the problems that could otherwise be
spotted during the endoscopy.
If you are still experiencing symptoms of
indigestion after taking antacids, alginates and PPIs, your doctor may suggest a
medicine known as a prokinetic.
There are two types of prokinetics available:
- domperidone
- metoclopramide.
Domperidone and metoclopramide help food pass
through your stomach and the first part of your small intestine (duodenum) more
quickly, so indigestion is less likely to occur. You may be prescribed domperidone by your doctor,
although it is also available over the counter in pharmacies
for people aged 16 or over.
Metoclopramide is only available on prescription
from your doctor. Both medicines can be taken in tablet or liquid form. If you are prescribed domperidone, you will need to
take it 15 to 30 minutes before a meal so it has time to work before your
symptoms of indigestion start.
If your indigestion symptoms are caused by an
infection with H. pylori bacteria, you will need to have treatment to clear the
infection from your stomach. This should help 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 (treatment with three different medications). Your doctor will prescribe a
course of treatment containing:
- two different antibiotics (medicines to treat
infections that are caused by bacteria)
- a PPI.
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.
Source: NHS Choices.