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Indigestion

Indigestion (also known as dyspepsia) is the term used to describe pain or discomfort in the upper abdomen or chest, generally occurring soon after meals.

About indigestion 

You get indigestion when the acid in your stomach refluxes (returns) back up your oesophagus (the pipe that goes from your mouth to your stomach). This happens if the sphincter (valve) at the top of your stomach doesn’t work properly. The medical term for this condition is gastro-oesophageal reflux disease (GORD). You can also get indigestion when your stomach is irritated or inflamed. Although indigestion is most common after meals, you can get it at any time.

Gastro Indigestion

Symptoms of indigestion 

If you have indigestion you may have the following symptoms:

  • pain, fullness or discomfort in the upper part of your abdomen or chest (heartburn)
  • loss of appetite
  • feeling sick
  • flatulence (gas passed from your rectum), burping or belching.

Depending on the cause of your indigestion, your symptoms may go very quickly, come and go, or they may be regular and last for a long time.

Visit your GP for advice if you have:

  • unexplained weight loss
  • unexplained and continual symptoms of indigestion for the first time and you're 55 or older
  • severe pain, or if the pain gets worse or changes
  • blood in your vomit, even if it's only specks of blood.

Causes of indigestion 

Your stomach acid helps you to digest food and protects you against infection. A layer of mucus lines your stomach, oesophagus and bowel to act as a barrier against this acid. If the mucous layer is damaged, your stomach acid can irritate the tissues underneath; or if the valve at the top of your stomach isn’t working properly, stomach acid can irritate the oesophagus, leading to indigestion.

Lifestyle triggers

Some of the following can trigger symptoms of indigestion:

  • drinking too much alcohol
  • smoking
  • stress and anxiety
  • medicines, such as aspirin and anti-inflammatory medicines, used to treat arthritis
  • certain foods and some drinks can relax the sphincter at the join between your oesophagus and stomach and may cause symptoms of indigestion, or cause direct irritation to the lining of your oesophagus
  • being overweight or obese can increase the pressure on your stomach and contribute to feelings of indigestion.

Underlying medical conditions

Some medical conditions can cause symptoms of indigestion and heartburn.

Peptic ulcers are ulcers in your stomach or the first part of your small intestine (duodenum). They occur when the lining of either your stomach or your duodenum is damaged and becomes inflamed. Peptic ulcers are usually caused by a bacterium called Helicobacter pylori (H. pylori). These bacteria live in the mucous layer of your stomach. Although they don't always cause symptoms, they can cause peptic ulcers in some people. Find more information about peptic ulcers.

Heartburn can be triggered by hiatus hernia. This happens when part of your stomach or sphincter moves up into your chest cavity, causing reflux. Find more information about hiatus hernias.

Certain types of cancer can also trigger the symptoms of indigestion, but this is rare.

Pregnancy

As many as 80 percent of pregnant women suffer from indigestion. This may be triggered by high levels of the female hormones progesterone and oestrogen, which relax your sphincter.

Symptoms are usually first experienced late in the first trimester (the first 12 weeks of pregnancy) and can continue throughout the remaining six months. The symptoms of indigestion usually go away within four weeks of giving birth.

Diagnosis of indigestion 

Your GP will ask about your symptoms and examine you. They may also ask you about your medical history.

If lifestyle changes and medicines don't help to improve your symptoms, your GP may recommend further tests, such as:

  • breath or blood tests. These tests are to detect the presence of H. Pylori which may indicate that you have a peptic ulcer.
  • gastroscopy. This is a procedure to look inside your oesophagus, stomach and duodenum using an endoscope (a small camera on the end of a long, flexible tube). During a gastroscopy your doctor may take a biopsy (a small sample of tissue). This will be sent to a laboratory for testing.
  • a barium swallow and meal X-ray. This is a test that involves swallowing a drink containing barium (a type of metal that illuminates the digestive organs during x-rays) so your doctor can get clear X-ray images of your abdomen.

Treatment of indigestion 

Self-help

There are a few things you can do to help reduce the symptoms of indigestion, including:

  • losing excess weight if you’re overweight or obese
  • cutting down on fatty foods, tea, coffee, alcohol and anything else that you think triggers your symptoms
  • stopping smoking
  • sleeping with the head of your bed raised by about 20-30cm with something sturdy and solid
  • eating at least two to three hours before going to bed if you have a peptic ulcer
  • reducing your stress levels - try relaxation techniques such as meditation, yoga and deep breathing
  • not eating too much or too quickly.

Medicines

Over-the-counter medicines

You can buy a range of indigestion medicines from your pharmacist without a prescription. Always read the accompanying consumer medicines information leaflet and if you have any questions, ask your pharmacist for advice.

Antacids are medicines that can relieve symptoms of indigestion by neutralising acid in your stomach. They can be taken as either liquid or tablets that can be swallowed or chewed. If antacids don't work, or if you need to take large quantities to relieve your symptoms, your pharmacist may recommend H2 blockers. These work by reducing the amount of acid that your stomach produces.

Another option is a low dose of a proton pump inhibitor. Proton pump inhibitors work by stopping your stomach producing acid. The proton pump inhibitors available without a prescription are pantoprazole (Somac) and rabeprazole (Pariet). These over-the-counter packs can be taken for a maximum of two weeks. See your GP if symptoms persist beyond this time.

Prescription-only medicines

If you need to take medicines for indigestion regularly, more than two or three times a week, your doctor may prescribe higher doses of proton pump inhibitors or H2 blockers to be used for a month. The doctor can then reassess whether you need to continue using this medication at this dose.

If a proton pump inhibitor is controlling your symptoms, your GP can prescribe you one for long-term use.

Another type of medicine you may be prescribed along with your proton pump inhibitor is a prokinetic or motility stimulant, which quickens the rate at which your stomach empties and helps stop your stomach contents refluxing back into your oesophagus.

If you have an H. Pylori infection, your GP may recommend having triple therapy to kill off the bacterial infection. This usually means taking a seven-day course of a proton pump inhibitor combined with two different antibiotics.

Always read the accompanying consumer medicines information leaflet and if you have any questions or concerns ask your pharmacist or doctor for advice.

Surgery

Surgery for indigestion or heartburn is rare. Your doctor will usually only recommend it if medicines don't work or if you don't want to take proton pump inhibitors for long periods of time, and you have weighed up the risks of having surgery against the benefits.

If you have a hiatus hernia and your symptoms are severe, your GP may refer you to a surgeon, who may recommend surgery to repair the hernia.

Talking therapies

Some people find that talking therapies, such as cognitive behavioural therapy (CBT) and psychotherapy, may help reduce the symptoms of indigestion.

Further information 

Gastroenterological Society of Australia
www.gesa.org.au

Sources 

Clinical Knowledge Summaries. Dyspepsia – pregnancy associated. [online] London: National Institutes for Health and Clinical Excellence. 2008 [accessed 5 Jul 2011] Available from: http://www.cks.nhs.uk/dyspepsia_pregnancy_associated

Clinical Knowledge Summaries. Dyspepsia – proven GORD. [online] London: National Institutes for Health and Clinical Excellence. 2008 [last updated Jul 2009, accessed 6 Jul 2011] Available from: http://www.cks.nhs.uk/dyspepsia_proven_gord

Clinical Knowledge Summaries. Dyspepsia – unidentified cause. [online] London: National Institutes for Health and Clinical Excellence. 2008 [last updated Jul 2009, accessed 6 Jul 2011] Available from: http://www.cks.nhs.uk/dyspepsia_unidentified_cause

Digestive Health Foundation (DHF). Gastro-oesophageal Reflux Disease in Adults. 4th ed. Sydney, NSW: Gastroenterological Society of Australia. 2008.

Festi D Scaioli E Baldi F et al. Body weight, lifestyle, dietary habits and gastro esophageal reflux disease. World J Gastroenterol. 2009; 15(14): 1690-1701.

Gastrointestinal Expert Group. Therapeutic guidelines: gastrointestinal. Version 4. Melbourne: Therapeutic Guidelines Limited. 2006.

Kaltenbach T Crockett S Gerson LB. Are Lifestyle Measures Effective in Patients with Gastroesophageal Reflux Disease? An Evidence-Based Approach. Arch Intern Med. 2006; 166: 965–971.

Merck Manuals Online Medical Dictionary. Gastroesophageal reflux (GERD). [online] Whitehouse Station, NJ: Merck, Sharp and Dohme Corp. [Last updated Oct 2007, accessed 5 Jul 2011] Available from: http://www.merckmanuals.com/professional/sec02/ch012/ch012g.html

Moayyedi P Talley NJ. Gastro-oesophageal reflux disease. Lancet. 2006; 367:2086-2100.

National Institute for Health and Clinical Excellence (NICE). Dyspepsia: managing dyspepsia in adults in primary care. [online] Aug 2004 [accessed 6 Jul 2011] Available from: http://guidance.nice.org.uk/CG17

National Prescribing Service (NPS). NPS Prescribing Practice Review 45: Proton pump inhibitors: step-down to symptom control [online]. 2009. NSW: NPS [accessed 25 Nov 2010] Available from: http://www.nps.org.au/health_professionals/publications/prescribing_practice_review/current/nps_prescribing_practice_review_45

Pharmaceutical Society of Australia (PSA). Heartburn and indigestion. 2009. NSW: PSA. Richter JE. Review article: the management of heartburn in pregnancy. Aliment Pharmacol Ther. 2005; 22: 749–757.

Rossi S (ed). Australian Medicines Handbook. Adelaide: Australian Medicines Handbook. 2009.

Stanghellini V. Relationship between upper gastrointestinal symptoms and lifestyle, psychosocial factors and comorbidity in the general population: results from the Domestic/International Gastroenterology Surveillance Study (DIGEST). Scand J Gastroenterol. 1999; Suppl 231: 29–37.

Last published: 30 July 2011

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