Don’t let indigestion and heartburn be a bad Christmas joke.

18 December 2018

Seven year old: “Mum, what happens if you eat lots of tinsel?”

Mum: “Probably emergency surgery to prevent obstruction somewhere in your digestive system. “

Seven year old: *blank face*, *small voice*, “You get tinselitis.”

Don’t let indigestion and heartburn be a bad Christmas joke. This time of year we over-indulge, find ourselves struggling to exercise and face ‘family’ stress, a side-effect of which can be spending hours bloated and in pain.

Thus we’ve asked Simon Middleton, a consultant general surgeon at Spire Dunedin Hospital, who specialises in colonoscopy, colorectal surgery, bowel cancer, inflammatory bowel disease, gastroenterology, hernia surgery and Rafaelo surgery, to provide some insight into the causes and treatment of indigestion, and more importantly how to avoid it altogether.

Simon Middleton

Note: suffering indigestion regularly and for an extended period of time could be symptomatic of something more sinister. Do make an appointment to see your GP or Gastroenterologist to discuss your health, if symptoms persist.

What is indigestion?

Indigestion is a very vague term that is used to describe symptoms that are attributable to the oesophagus, stomach and small intestine (duodenum). The symptoms are often pain or discomfort aggravated by eating or drinking - the feeling of nausea after food or the sensation of being over full. Also, heartburn and reflux can also be described as indigestion.

How is it usually caused?

It is classically caused by acid reflux disease, gastritis (inflammation of the stomach) or ulcers in the stomach or small intestine. The stomach has natural defences against stomach acid but if this defence is damaged then problems can arise from naturally occurring acid.

The oesophagus, on the other hand, has no natural protection so acid refluxing out of the stomach into the oesophagus will cause symptoms. Helicobacter pylori - a bacteria frequently found in peoples stomach - can tip the balance towards damage from stomach acid.

Other things that increase stomach acid production can promote symptoms. These include smoking, acidic drinks such as wine and fruit juices and spicy food. Stress is another possible trigger.

Are there any causes that people aren’t so aware of?

The bottom of the oesophagus (gullet) has a muscle 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 result 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. However, 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 from alcohol and saying ‘no' to tempting treats, what measures can people take to avoid indigestion?

Eating and drinking a number of hours before going to bed is a good option. Smaller and frequent meals tend to help as well. If reflux is the major issue raising the head of the bed up, either on blocks of wood or bricks, helps increase the effect of gravity at night thus reducing reflux.

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 directly connected 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 only antacids that will neutralise the stomach acid for a relatively short period.

What conditions could the symptoms of indigestion be hiding?

The real worry about indigestion is that it could be masking something much more sinister. If lifestyle issues and a short course or tablets/medicine - maybe two weeks of treatment - does not resolve the issue then seeking medical advice is sensible.

The diseases that mimic indigestion are stomach and pancreatic cancer and gallbladder disease. Ulcers of the stomach and small intestine need to be diagnosed and treated effectively as the huge majority are curable without prolonged treatment.

The increasing age of the patient and the fact that these symptoms are new are indicators to investigate further. Oesophageal cancer can give symptoms similar to reflux and any sensation of food sticking and painful swallowing require urgent investigation.

Visit your GP or a gastroenterologist as soon as possible if you're concerned – for most people, a course of medication and lifestyle advice will ensure symptoms reduce.

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