18 December 2017
Christmas is the season to be jolly - but it is also often the time when stress, over indulgence and a lack of exercise can see many of us suffering rather uncomfortable bouts of indigestion.
Is it just a part of the Christmas celebrations or can you enjoy the extra treats without’ suffering the consequences’?
Dr Middleton, a Consultant Gastroenterologist at Spire Cambridge Lea Hospital, looks at the causes of indigestion, how we treat it and what we have to do to avoid it altogether.
But he also warned that people suffering indigestion regularly should consult their GP to see if any investigations are required.
What is indigestion? Indigestion and dyspepsia have the same meaning and describe symptoms consisting of upper abdominal discomfort or pain which is either increased or decreased by food or drink. It can include the feeling of nausea or the sensation of being over full. Also, heartburn and gastro-oesophageal reflux symptoms can also be described as indigestion.
How is it usually caused? It is often caused by acid reflux, gastritis (inflammation of the stomach) or ulcers in the stomach or duodenum. The stomach has natural defence against stomach acid but if this defence is damaged then problems can arise from naturally occurring stomach acid.
The oesophagus on the other hand has far less natural protection so acid refluxing out of the stomach into the oesophagus will cause symptoms and can damage the lining. Helicobacter pylori - a bacteria frequently found in the stomach - can tip the balance towards damage from stomach acid.
Other things that increase stomach acid production can promote symptoms, include smoking, acidic drinks such as wine and fruit juices and spicy food as well as Non-steroidal anti-inflammatory drugs such as Ibuprofen (these drugs are often taken for headaches over the Christmas period). Stress is another possible trigger.
Are there any causes that people aren’t so aware of?
The bottom of the oesophagus (gullet) has a muscular valve that tries to prevent reflux. However, this muscle can be relaxed by alcohol and, perhaps more surprisingly, by chocolate. Late night chocolate treats can classically results in nocturnal heartburn
What about alcohol – are spirits more likely to bring on a bout of indigestion than beers or lagers?
All alcohol will relax the lower oesophagus and promote reflux but fizzy drinks, such as lager, are more likely to cause reflux, especially when drunk in larger volumes. Furthermore, all alcohol will cause some damage to the stomach so don’t believe the medical myth that you can use brandy to settle your stomach!
Besides abstaining for alcohols and saying ‘no’ to tasty treats what measures can people take to avoid indigestion?
Allowing a few hours after eating and drinking before going to bed is a good option. Smaller and more frequent meals rather than less frequent but large meals tends to help as well. If reflux is the major issue propping the head of the bed on a couple of bricks helps increase effect of gravity at night thus reducing reflux (sleeping with your head on pillows is often not effective and can even make reflux worse).
Does a pint of milk at the start of the evening help or is that an ‘old wives tale’ started by the dairy industry?
Funnily enough, while the pint of milk theory is another ‘medical myth’ it is a fact that before the advent of modern anti-acid drugs, patients with ulcers were often treated with milk drips direct to the stomach.
If you do get indigestion what is the best way of treating it?
Modern drugs such as the PPIs (omeprazole etc) have transformed the management of indigestion by reducing acid production very dramatically. Also H2 blockers such as (ranitidine) reduce acid production. However, many of the over-the-counter remedies are antacids that will reduce the acidity of the stomach for a relatively short period and may also provide a protective layer over the lining which can also help for short periods of time.
What conditions could the symptoms of indigestion be hiding?
Occasionally, symptoms of indigestion could indicate something more serious. If lifestyle changes and a short course or tablets/medicine - maybe two weeks of treatment - does not resolve the issue then seeking medical advice is sensible. An appointment with your GP can often provide much valued reassurance or lead on to important tests to deal with your problem at an early stage before it gets too serious.
Gall bladder disease such as gall stones can produce symptoms of dyspepsia and these do not usually respond to acid suppressing drugs.
If you do experience more than short lived indigestion then your GP will be able to assess them and arrange appropriate tests and/or referral on to a gastroenterologist specialist opinion as required.
Some symptoms such as difficulty swallowing, indigestion associated with weight loss or vomiting should lead to a prompt appointment with your GP as they often need more rapid investigation and treatment, and have less chance of resolving spontaneously.
The overall message for gastro-intestinal health during the Christmas festivities is to indulge with moderation and if you have a tendency for indigestion try to avoid the key factors as mentioned above that might precipitate them.