Indigestion

Indigestion refers to a group of symptoms often caused by eating or drinking and is not a disease. The most common symptoms are heartburn, a burning sensation in your stomach and pain in your upper abdomen (which is where your stomach is located) — pain can range from mild to severe. Other indigestion symptoms include:

• Acid reflux — bringing up a bitter-tasting fluid 
• Bloating or a feeling of tightness in your upper abdomen — this is caused by a build-up of gas
• Feeling overly-full as soon as you start eating or when you finish — you may be unable to finish your meal due to uncomfortable fullness, and fullness after your meal may last longer than usual
• Flatulence and burping
• Nausea and/or vomiting

Most people have bouts of indigestion from time to time, especially pregnant women. However, some people have indigestion more often, sometimes every day. 

Usually, you can relieve symptoms on your own with lifestyle changes and/or over-the-counter medication. However, if you often get indigestion and it’s very painful, it could be a sign you have an underlying medical condition, such as gallbladder disease, gastro-oesophageal reflux disease (GORD) or ulcers.

Normally when you eat food, stomach acid is produced to help digestion. Indigestion sometimes occurs when too much stomach acid is produced and irritates the lining of your stomach, the top part of your bowel or your gullet (oesophagus). This can cause bloating, soreness and a burning sensation in your upper abdomen. 

Indigestion often occurs after eating too much or too fast. It can also be caused, or made worse, by:

• A problem with your digestive system eg peptic ulcer disease
• Certain medicines eg anti-inflammatory drugs
• Coeliac disease
• Drinking alcohol or eating fatty or fried foods
• Smoking
• Stress and/or tiredness — stress increases your risk of acid reflux

Being overweight can also cause indigestion as it increases your risk of acid reflux. 

Ulcers in your stomach and the top part of your small intestine (duodenum) can cause indigestion too. However, ulcers are becoming less common as they are often caused by the bacteria Helicobacter pylori, which is less prevalent in the UK today. 

Ulcers are more common in people who smoke or take certain anti-inflammatory drugs to treat joint and muscle pain, which can damage the stomach lining. You may also be at greater risk of developing ulcers if you have close family members with ulcers as they can run in families.

Your heart sits near your stomach, which is why it can be hard to determine whether upper abdominal pain is caused by your stomach or your heart. Both indigestion and a heart attack can sometimes cause back pain. 

Call 999 if you have any of the following symptoms, as well as indigestion:

• A rapid or irregular heartbeat (palpitations) 
• Chest pain — this pain may spread to your arms, shoulder, neck or jaw
• Difficulty breathing
• Sweating
• Tightness or heaviness in your chest

Frequent indigestion can be a sign of an underlying condition, including:

• • Acid reflux and gastro-oesophageal reflux disease (GORD)
  • Hiatus hernia
  • Inflammation of your stomach (gastritis) and/or small intestine
  • Stomach and duodenal ulcers
  • Stomach cancer

You should seek immediate medical attention if you: 

• Have black, tar-like stools
• Have blood in your stool
• Have blood in your vomit — in some cases, this may look like coffee grounds in your vomit as the blood has clotted together

You should see your GP if you: 

• Are unintentionally losing weight
• Are vomiting regularly
• Have difficulty swallowing
• Have frequent, very painful indigestion symptoms for the first time and are aged over 55 
• Have indigestion symptoms for more than a few weeks
• Have indigestion symptoms that are not improving with over-the-counter medications

Your GP will discuss your symptoms with you and may examine your abdomen.

Depending on your symptoms and their severity, your GP may refer you for tests to rule out certain diseases — this will determine what treatment you need. Tests may include:

• A breath test to check for Helicobacter pylori, a bacterial infection that can cause stomach ulcers
• A gastroscopy (endoscopy) to look at your digestive system for conditions such as a stomach ulcer or hiatus hernia
• A stool sample or blood test

If the results are inconclusive, your GP may refer you for further tests or to a gastroenterologist, a consultant specialising in the digestive system.

Home remedies

• Apple cider vinegar — if your indigestion is caused by too little stomach acid, this may help as it increases the production of stomach acid
• Chamomile tea — this can ease indigestion by reducing stomach acid in your gullet and bowel
• Ginger — this can reduce stomach acid levels 
• Lemon water — this can help neutralise stomach acid and improve digestion
• Peppermint tea — this can ease indigestion but should not be taken if your indigestion is caused by acid reflux

Lifestyle

Certain lifestyle changes can provide indigestion relief. Try to:

• Avoid foods that trigger your indigestion — these might be rich, spicy and/or fried foods; you can try replacing theses trigger foods as below: 
• Acidic drinks (eg citrus and fruit juices, soft drinks) — replace with plain water or very diluted squash
• Fresh garlic and onions — replace with dehydrated versions 
• Fried foods — replace with baked, grilled, poached or roasted foods
• Spices — replace with ginger and herbs eg basil, oregano and thyme
• Avoid smoking, caffeine and alcohol
• Avoid stress or find a way to relieve your stress
• Eat regular meals and have your evening meal at least three hours before bedtime
• Lose any excess weight

Medication

You may find that taking over-the-counter indigestion remedies bring relief, such as antacids.

Your GP can also prescribe stronger antacids or:

• H2 receptor antagonists to reduce your stomach’s acidity level
• Proton pump inhibitors (PPI) to reduce how much acid your stomach produces

If you’re taking a medication that can cause indigestion, your GP may change your medication or alter the dosage.

Other medications and treatment options are available if your indigestion is found to be due to an underlying cause, such as a stomach ulcer or GORD.

If you are pregnant, you are more likely to have indigestion. This is due to: 

• Growth of your baby in the later stages of pregnancy — your growing baby will cause your womb to push your stomach upwards and apply pressure to your intestines; this slows digestion and leaves less space for your stomach to hold food, which can make you feel fuller after only eating a small meal
• Heartburn — your muscles relax during pregnancy, including the muscles between your stomach and gullet, which makes it easier for stomach acid to pass up into your gullet causing heartburn and indigestion symptoms
• Hormonal changes — the hormone progesterone increases during pregnancy and causes your muscles to relax, including the muscles around your intestines, which slows digestion and consequently can cause indigestion

Treating indigestion when pregnant

You may not be able to take certain medications when pregnant. However, you can make lifestyle changes to ease your indigestion symptoms. This includes: 

• A food curfew — avoid eating food two to three hours before bedtime
• Relaxation techniques — medication or quiet time before bedtime can help relax your body 
• Sleeping positions — elevate your head and shoulders slightly using an extra pillow to help prevent stomach acid passing up into your gullet