Indigestion

The stomach produces a strong acid that helps digest food and protects against infection. A barrier of mucus lines the stomach, oesophagus and intestines to act as a barrier against this acid. If this protection is damaged, acid can irritate the tissues below, leading to pain.

With heartburn, the sphincter (valve) at the join between the oesophagus and stomach does not work properly.

Some common causes of indigestion include:

• eating a heavy meal or drinking alcohol
• smoking
• irregular meals - long gaps between meals allow the acid more time to act. Each meal neutralises the acid for a while
• stress and anxiety
• drugs such as aspirin and anti-inflammatory medication used to treat arthritis
• pregnancy  - commonly causes heartburn, indigestion or vomiting
• peptic ulcer (stomach ulcer) – a raw patch in the lining of the stomach or the small intestine

Other causes:

• Helicobacter pylori (H. pylori) – This is a type of bacteria, which lives in the mucus lining the stomach, that can lead to symptoms of indigestion. It is present in about half the population, but may cause no symptoms. However, a high percentage of people who suffer from a stomach ulcer are found to carry the bug and about 15% of people who carry the bug will develop an ulcer. It is possible that a small proportion of people who are affected will develop stomach cancer. If the bug is found to be present it can be treated with a one-week course of tablets (see Treatment, below).
• Hiatus hernia – occurs when part of the stomach slides through the diaphragm, the muscular sheet that separates the lungs and chest from the abdomen. Normally, the oesophagus passes through a small opening in the diaphragm. But in some people this opening is wide enough to allow part of the stomach to slide up into the chest. This is called a hiatus hernia, and it causes pain and heartburn. This hernia is most likely to occur after a large meal, in pregnant women and people who are overweight. If the symptoms are severe, it can be repaired by an operation.

A number of lifestyle changes may reduce indigestion:

• Dietary changes - reduce your intake of tea, coffee and alcohol. Eat small regular meals
• Stop smoking – if you smoke, try to stop, or at least cut down
• Reduce stress wherever possible

Non-prescription medicines

A range of indigestion treatment can be bought from the pharmacy without a prescription. These include:

• Antacids - either in liquid or tablet form. They generally work by neutralising the stomach acid. Some contain an ingredient called an alginate which forms a barrier that floats on the top of the stomach contents and prevents them splashing back up into the gullet, thus preventing heartburn and reflux symptoms. Antacids can be taken anytime. Some contain magnesium, which can cause looseness of the bowels, others contain aluminium, which can cause constipation. Many of the antacids contain a mixture of both.
• H2 antagonists. If antacids don’t work, or if large quantities of antacid (more than 50ml per day) are needed, seek advice from a pharmacist, who may recommend a more powerful medication. One group of more powerful drugs that can be bought at a pharmacy is known as H2 antagonists. They work by reducing the amount of acid produced by the stomach. Examples are famotidine (Pepcid AC) and ranitidine (Zantac).

Prescription-only medicines

If symptoms continue, GPs can prescribe another type of drugs called proton pump inhibitors.  Examples are omeprazole (Losec) and lansoprazole (Zoton).

Other medications coat the stomach lining, protecting it against the acid-attack. These include bismuth, sucralfate or carbenoxolone.

H. pylori can be treated with triple therapy, which is usually a high dose of a proton pump inhibitor combined with two different antibiotics for one week.

Investigations

If your symptoms have not responded to lifestyle changes or treatment, your GP may recommend further tests:

• A breath test or a blood test to detect the presence of H pylori.
• Barium meal X-ray – this is used to view the oesophagus, stomach and the duodenum (first part of the small intestines). The test involves a series of X-rays taken after swallowing a drink containing barium – a chemical element that shows up on an X-ray picture. This outlines the lining of the digestive tract and can show up any abnormalities such as ulcers, narrowing (known as strictures) or a cancer. Reflux can be seen during the procedure.
• Endoscopy. This is an examination with a fibre optic tube, which is passed through the mouth down the oesophagus and into the stomach. The camera sends images that can be seen on a TV screen. A biopsy – small sample of the stomach lining for laboratory analysis– can be taken if necessary. This biopsy may show the presence of H. pylori, inflammation of the stomach lining, or cancer.

If these tests fail to uncover the underlying problem, then an ultrasound scan, CT scan or MRI scan may be used to look at the other organs such as the liver, gallbladder, pancreas, bowels or kidneys.

For heartburn symptoms occurring at night, it may help to raise the head of the bed and sleep in a slightly more upright position because the action of gravity reduces reflux.

To help prevent indigestion, the best advice is to stick to eating regular meals, and a balanced diet. Don't smoke or drink excessively and aim to maintain a healthy weight, appropriate for your height.

This information was published by Bupa's health information team and is based on reputable sources of medical evidence. It has been peer reviewed by Bupa doctors. The content is intended for general information only and does not replace the need for personal advice from a qualified health professional.

Digestive Disorders Foundation
www.digestivedisorders.org.uk

National Institute of Diabetes and Digestive and Kidney Diseases
http://www.niddk.nih.gov/health/digest/summary/ind/index.htm