Clinical health information Indigestion September 11 2019
Judith Ngai Judith Ngai Health writer

Ever wondered why some people seem to get indigestion more than others? We look at causes and ways to manage indigestion.

Indigestion is a term to describe an experience that generally happens soon after meals where the main symptom is pain or discomfort in the chest (known as heartburn) and/or in the upper abdomen. 

About indigestion 

You get heartburn 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 relaxes when it shouldn’t, doesn’t work properly, or when your stomach produces too much acid. Most people get the occasional episode of heartburn but frequent or severe heartburn may be a symptom of a medical condition called gastro-oesophageal reflux disease (GORD). You can also get indigestion when your stomach lining is irritated or inflamed. Although indigestion is most common after meals, you can get it at any time.

Symptoms of indigestion 

In addition to heartburn or pain and discomfort in your abdomen, you may have some of the following symptoms, depending on what is causing your indigestion.

  • A poor appetite 
  • Feeling sick 
  • Regurgitating food (can be a small amount or feel more like you’re vomiting)
  • Flatulence (gas passed from your rectum), burping or belching
  • Constipation or diarrhoea.

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, particularly if you are over 50, if you have:

  • persistent indigestion that doesn’t respond to simple measures or medication given to you by your GP 
  • nausea or vomiting, particularly if it is recurring
  • unexplained weight loss
  • loss of appetite
  • difficulty swallowing or pain when you swallow
  • blood in your vomit, even if it's only specks of blood
  • blood in your stools.

See your GP immediately if you experience a single sudden episode of indigestion or any indigestion that it is accompanied by shortness of breath, sweating or a fast heart rate. You could be having a heart attack. 

If you often get indigestion when you exercise or exert yourself, then see a doctor as soon as you can. You may have a heart condition and could be experiencing angina chest pain rather than indigestion. Unmanaged angina could result in a heart attack in the future.

Causes of indigestion 

Lifestyle triggers

Some of the following can trigger symptoms of indigestion:

  • drinking too much alcohol or eating a large meal
  • smoking 
  • stress and anxiety 
  • being physically active soon after eating
  • certain foods and some drinks - trigger foods differ for people and can include spicy, high-fat, or acidic foods
  • being overweight or obese can increase the pressure on your stomach and contribute to feelings of indigestion.

Underlying medical conditions and their treatments

Some medical conditions can cause symptoms of indigestion.

Peptic ulcers are round or oval sores 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.  For more information about peptic ulcers, click here.

Heartburn can be triggered by hiatus hernia. This happens when part of your stomach or sphincter moves up into your chest cavity, causing reflux. 
Delays in emptying your stomach can also cause indigestion. It can occur in people who have diabetes or a neurological disorder when the nerves to the stomach and intestines become damaged or don’t work properly.

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

Some medicines to treat other conditions you may have, such as aspirin and anti-inflammatory medicines, certain antibiotics, medicines with anticholinergic or smooth muscle-relaxing properties or oral bisphosphonates (for osteoporosis) may make reflux symptoms worse, often by irritating the lining of your oesophagus and stomach.

Pregnancy

As many as 80 percent of pregnant women experience indigestion. In early pregnancy, indigestion may be triggered by high levels of the female hormones progesterone and oestrogen, which relax your stomach sphincter. In later pregnancy, it can be caused by your baby pushing up against your stomach.

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 is responsible for causing most stomach ulcers. 
  • 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.

Treatment of indigestion 

Self-help

There are a few things you can do that may 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 
  • 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. 
  • H2 blockers work by reducing the amount of acid that your stomach produces. 
  • Proton pump inhibitors also reduce the amount of acid in your stomach. Some low-dose proton pump inhibitors are available without a prescription - 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 or two. The doctor can then reassess whether you need to continue using this medication at this dose.

If a proton pump inhibitor is managing your symptoms, your GP can prescribe you one for long-term use. They will regularly review your treatment to see whether you need to continue taking your proton pump inhibitor; can be prescribed a lower dose; or even just take it when you need to (in conjunction with other measures).

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, if you have a particular underlying cause that can be appropriately treated by surgery (e.g. hiatus hernia), 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.

Further information 

Gastroenterological Society of Australia: www.gesa.org.au.

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Judith Ngai Judith Ngai Health writer Judith is a pharmacist and health content specialist.

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