Indigestion

Symptoms of indigestion 

Heartburn is when acid moves up from the stomach into the gullet (oesophagus) and causes a burning pain behind the lower part of your breastbone. 

Indigestion (dyspepsia) pain describes pain below the breastbone. Indigestion and heartburn can occur together or on their own.

As well as heartburn, other common symptoms of indigestion include:

• feeling uncomfortably full or bloated
• feeling sick
• belching or passing wind (flatulence)
• bringing up food or fluid from your stomach

These symptoms usually occur soon after eating or drinking. There can sometimes be a delay between eating and getting indigestion.

Causes of indigestion 

Indigestion (dyspepsia) symptoms can be caused by several things, including:

Gastro-oesophageal reflux disease (GORD) 

Gastro-oesophageal reflux disease (GORD) is a common condition and one of the main causes of recurring indigestion.

It occurs when the muscle between the oesophagus and stomach fails to prevent stomach acid rising into the oesophagus.

Peptic ulcer disease 

A peptic ulcer is an open sore that develops on the inside lining of your stomach (gastric ulcer) or small intestine (duodenal ulcer).

Indigestion may be a symptom if you have a stomach ulcer.

Peptic ulcers form when stomach acid damages the lining in your stomach or duodenum wall. In most cases, the lining is damaged as a result of an H. pylori infection.

Helicobacter pylori (H. pylori) infection 

Helicobacter pylori infections are common. It is a type of bacteria (germ).  H. pylori infection is often present in people who have peptic ulcers.

There are tests that can identify if you have a H. pylori infection. Treating the infection with antibiotics will help in treating the ulcer, promoting healing.

Non-ulcer dyspepsia (also known as functional dyspepsia) 

In non-ulcer dyspepsia, there are symptoms of indigestion. Investigations will have ruled out the following:

• gastric ulcer
• duodenal ulcer
• cancer
• oesophagitis

 Often tests also show there is no reflux disease.

There are certain risk factors that make it more likely you will experience non-ulcer dyspepsia, including:

• Helicobacter pylori infection - H. pylori gastritis is detected in about half of people with this condition
• lifestyle choices:
  • ​​​​​​obesity - if you're overweight or obese, you're more likely to get indigestion
  • smoking - the chemicals inhaled in cigarette smoke may contribute to indigestion
  • ​​​​​​alcohol - drinking excess amounts of alcohol can also increase your risk of getting indigestion (alcohol causes your stomach to produce more acid than normal, which can irritate your stomach lining)
  • excess coffee and excess fat intake have also been linked to dyspepsia

Other causes of indigestion (dyspepsia) include:

Medication 

Some medicines, such as nitrates – taken to treat angina (chest pain) – relax the ring of muscle between the oesophagus and stomach. This allows acid to leak back up.

Non-steroidal anti-inflammatory drugs (NSAIDs), such as aspirin and ibuprofen, can also affect your digestive tract and cause indigestion. 

Don't take NSAIDs if you have stomach problems, such as a stomach ulcer, or you've had problems in the past.

Children under the age of 16 shouldn't take aspirin.

There are many medications that can potentially cause dyspepsia in some people.

If your GP thinks the medication you're taking could be contributing to your indigestion, they may recommend changing it.

Pregnancy 

Indigestion in pregnancy is partly caused by hormonal changes and by the growing womb pressing on your stomach in the later stages of pregnancy.

Stress or anxiety 

Stress or anxiety can sometimes contribute to the symptoms of indigestion.

 Hiatus hernia 

A hernia occurs when an internal part of the body pushes through a weakness in the surrounding muscle or tissue wall.

A hiatus hernia is where part of the stomach pushes up into the diaphragm, the sheet of muscle under your lungs. This can cause acid reflux.

Barrett's oesophagus 

Repeated episodes of GORD can sometimes lead to changes in the cells in the lining of your lower oesophagus. This is known as Barrett's oesophagus.

It's estimated that about one in every ten people with GORD will develop Barrett's oesophagus, usually after many years.

Barrett's oesophagus doesn't usually cause noticeable symptoms, other than those caused by GORD.  

However, there's a small risk the changed cells could become cancerous in the future. Your doctor may suggest having an endoscopy every few years to check for this.

Stomach and oesophageal cancer 

In rare cases, recurring bouts of indigestion can be one of the symptoms of stomach cancer, or cancer of the oesophagus.

Cancerous cells in the stomach or oesophagus break down the protective lining, allowing acid to come into contact with the stomach or oesophagus wall.

There are certain risk factors that would make it more likely that cancer could be present.

When to see your GP 

There's usually no need to seek medical advice for indigestion as it's often mild and infrequent and specialist treatment isn't required.

You should see your GP if you have recurring indigestion and any of the following apply:

• you're 55 years of age or over
• you've lost a lot of weight without meaning to
• you have difficulty swallowing (dysphagia)
• you have persistent vomiting
• you have iron deficiency anaemia
• you have a lump in your stomach
• you have blood in your vomit or blood in your stools

These symptoms may be a sign of a more serious underlying health problem, such as a stomach ulcer or stomach cancer.

Also see your GP if you get indigestion regularly, if it causes you severe pain or discomfort, or if your regular anti-reflux remedies stop working.

Your GP will ask you about your symptoms and:

• any other symptoms you have that may show an underlying health condition
• any medication you're taking – as some medications can cause indigestion
• your lifestyle – some lifestyle choices, such as smoking, drinking alcohol or being overweight, can cause indigestion 

Your GP may also press gently on different areas of your stomach to see if this is painful and to see if there are any lumps, or assess whether any of your internal organs are swollen.

Depending on your symptoms, your GP may want to investigate further.

Your GP may refer you for a hospital procedure called an endoscopy to rule out a more serious cause of your indigestion. For example a stomach ulcer, or stomach cancer.

During an endoscopy, a thin, flexible tube with a light and camera at one end, called an endoscope, is used to examine the inside of your body.

You may need further tests to rule out other underlying conditions that could be causing your indigestion symptoms. For example, abdominal pain and discomfort can be caused by conditions that affect the bile ducts in your liver.

Treating indigestion 

Treatment for indigestion will vary, depending on what's causing it and how severe your symptoms are.

Most people are able to manage their indigestion, by making simple diet and lifestyle changes, or taking medication such as antacids.

Lifestyle changes 

Lifestyle changes include:

• losing weight if you're overweight - it's important to lose weight safely and steadily through regular exercise and by eating a healthy, balanced diet
• avoiding foods that seem to make your indigestion worse, such as rich, spicy and fatty foods
• cutting down on caffeinated drinks, such as tea, coffee, cola, and alcohol
• smoking can contribute to indigestion - there is free specialist advice available to help you quit smoking (stop smoking support services, through GP practices and community pharmacies, are available across Northern Ireland)
• if you tend to experience the symptoms of indigestion at night, avoid eating for three to four hours before you go to bed
• when you go to bed, prop your head and shoulders up with a couple of pillows, or raise the head of your bed by a few inches by putting something underneath the mattress - the slight slope should help prevent stomach acid moving up into your oesophagus while you're asleep

Medication 

There are medicines that can help if you have symptoms of indigestion.

These include antacids and alginates - medicine that can provide immediate relief for mild to moderate symptoms of indigestion and reflux.

You can buy them over the counter from most pharmacies without a prescription (ask your pharmacist for advice).

If you have persistent or recurring indigestion, treatment with antacids and alginates may not be effective enough to control your symptoms.

Your GP may recommend a different type of medication and will discuss this with you.

More useful links

• Indigestion
• How to use your health services