Indigestion
Indigestion is the name for a cluster of unpleasant sensations in the upper abdomen and behind the breastbone that come on while eating or shortly afterwards.
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Medicines commonly prescribed for Indigestion
For informational purposes only. Always consult a doctor before using any medicine.
Dosage form: TABLET, 20 mg pantoprazoleActive substance: pantoprazoleManufacturer: Almus Farmaceutica S.A.U.Prescription requiredDosage form: INJECTABLE, 40 mgActive substance: pantoprazoleManufacturer: Reiwa Healthcare S.L.Prescription requiredDosage form: TABLET, 20 mg/tabletActive substance: pantoprazoleManufacturer: Teva Pharma S.L.U.Prescription required
Indigestion is the name for a cluster of unpleasant sensations in the upper abdomen and behind the breastbone that come on while eating or shortly afterwards. Doctors more often call it dyspepsia. It is not a diagnosis but a description of symptoms, and behind it may lie anything from an ordinary response to too large a supper, through acid coming back up into the oesophagus and an ulcer, to something serious, which is far rarer. Most people get indigestion now and then, it settles by itself and it needs neither tests nor medicines. It is worth looking into when it goes on for weeks or comes with warning signs.
What it feels like
The mix of sensations differs from person to person and they need not all be present.
- Burning behind the breastbone that rises from below — what is called heartburn. Usually after eating, when bending over and when lying down.
- Heaviness and fullness high in the abdomen after only a small meal.
- Feeling full early: a few spoonfuls and the appetite has gone.
- Bloating, rumbling, frequent belching.
- Nausea and sometimes vomiting.
- A sour or bitter taste in the mouth, fluid and food rising into the throat.
- A dull or burning feeling just below the breastbone that comes and goes.
It helps to separate indigestion from what it is not. Pain all over the abdomen, cramping pain low down, back pain and a change in bowel habit are not part of dyspepsia, and they should not be put down to the stomach: they have other causes and are looked into separately.
When the trouble is not in the stomach
Articles about heartburn hardly ever mention this, and yet it matters more than anything else here. Burning and pressure behind the breastbone can come from the heart rather than the oesophagus. A heart attack often feels exactly like indigestion, particularly in women, in older people and in people with diabetes, and hours get lost taking one antacid after another.
Call an ambulance (in Spain, Italy, Portugal, Poland and Ukraine the single European number 112 answers) if burning or pressure in the chest:
- has come on for the first time and lasts more than a few minutes without easing;
- appears on exertion or in cold air and settles with rest;
- spreads to the arm, the neck, the jaw or between the shoulder blades;
- comes with breathlessness, cold sweat, faintness, sudden weakness or palpitations;
- comes with fear and a sense that something serious is happening.
An ambulance is also needed in other situations: vomiting blood or material like coffee grounds, black tarry stools, sudden severe abdominal pain with a rigid abdominal wall, or being unable to swallow even saliva. Do not drive with any of these.
Signs that should not wait
These do not call for an ambulance, but they should not be left to run either — book an appointment within the next few days.
- Swallowing is getting harder: solids stick first, then liquids too. Or swallowing hurts.
- Weight is falling by itself, with no dieting and no effort.
- Vomiting recurs day after day.
- A blood test has shown anaemia or iron deficiency with no obvious explanation.
- A lump can be felt in the upper abdomen.
- Indigestion has started for the first time later in life, or has clearly changed in character.
- Symptoms persist for more than a few weeks despite pharmacy remedies, or return the moment they are stopped.
- Close relatives have had similar illnesses, particularly cancer of the stomach or oesophagus.
None of these on its own means a tumour. Together, though, they mark out the people who need an endoscopy rather than another packet of tablets.
What sets indigestion off
There are several mechanisms, and one person may have two or three of them at once.
- Acid contents washing back into the oesophagus. The muscular valve between oesophagus and stomach does not close tightly, and acid irritates a lining that is not built for it.
- Meals that are too large, too fatty or too spicy, late suppers, eating in a hurry, talking while eating and swallowing air.
- Excess weight. Fat around the middle raises the pressure inside the abdomen and quite literally squeezes the stomach contents upwards.
- Smoking and alcohol. Both relax the valve, and alcohol irritates the lining as well.
- Medicines. Most often painkillers of the non-steroidal anti-inflammatory group, including ibuprofen and aspirin; also some blood pressure drugs, iron and certain antibiotics. Do not stop prescribed treatment on your own — discuss an alternative, or protection for the stomach, with your doctor.
- Stress and anxiety. The effect is not imaginary: anxiety alters how the stomach moves and makes its wall more sensitive to ordinary stretching.
- An ulcer of the stomach or duodenum, inflammation of the lining, a hiatus hernia.
- The bacterium Helicobacter pylori — the commonest removable cause, dealt with below.
- Functional dyspepsia. The tests find nothing, yet the symptoms are real and get in the way of life. This is not imagination and not "just nerves": the stomach is not working as it should, the changes simply do not show up on examination. It is very common.
What helps without medicines
This is the sensible place to start, and for many people it is where the whole thing ends.
- Eat smaller portions more often. A full stomach opens the valve almost every time.
- Have the last meal three to four hours before bed. Night-time reflux is the most damaging, because the acid sits in the oesophagus for hours.
- Raise the head of the bed by a hand's width, with blocks under the legs or a wedge under the mattress. A pile of pillows will not do: it folds the body and only raises the pressure inside the abdomen.
- Lose weight if there is weight to lose. Of everything on this list, it delivers the most.
- Stop smoking and cut down on alcohol, especially in the evening.
- Avoid tight belts and shapewear.
- Do not lie down or bend over straight after eating, and lift heavy things with the legs rather than the belly.
- Work out your own triggers. There is no universal list of forbidden foods: coffee, strong tea, chocolate, mint, tomatoes, citrus, fizzy drinks, fatty and spicy dishes come up most often, but the set is personal. A week of brief notes on what was eaten and what followed is worth more than cutting out everything blindly.
- Eat slowly and chew properly.
Pharmacy remedies and where they stop
Several groups are sold without prescription and they work in different ways.
- Antacids neutralise the acid already produced. They act fast but briefly — a remedy for a particular episode.
- Alginates form a dense layer on top of the stomach contents that physically gets in the way of reflux. They suit the period after meals and bedtime especially well.
- Acid-suppressing medicines — H2 receptor blockers and proton pump inhibitors. Slower to act but longer lasting, and taken as a course.
The important thing is to know where the limit lies. These remedies are meant for occasional episodes and short courses. If they are needed every day for weeks and months, the problem is not that the dose is too small but that the cause has not been found. Taking them long term without supervision is not harmless, and it also blunts the warning signs, so that serious illness is picked up later than it might have been.
Do not take ibuprofen, aspirin or other anti-inflammatory painkillers to settle stomach pain: they do the exact opposite and can end in an ulcer and bleeding.
Helicobacter and other checks
Popular articles on indigestion tend to stay quiet about this bacterium, and yet it is the commonest cause that can be got rid of once and for all. Helicobacter pylori lives in the stomach lining, keeps a low-grade inflammation going, causes most ulcers and raises the risk of stomach cancer. Carrying it is very common and produces no symptoms for years.
Finding it is straightforward: a breath test, a stool or blood test, or a look during endoscopy. Before testing it matters to stop proton pump inhibitors and antibiotics some weeks beforehand, otherwise the result comes back falsely negative. If the bacterium is there, a combination of several medicines is prescribed, and a month or six weeks after the course ends a check is always done to confirm it has gone.
Endoscopy — inspecting the oesophagus, stomach and the beginning of the intestine with a flexible tube and camera — is not for everyone. It is done when there are warning signs, when symptoms start later in life, or when treatment is not working. While there, the doctor takes small samples of the lining for analysis. Where needed, an abdominal ultrasound scan, blood tests and a twenty-four-hour measurement of acidity in the oesophagus are added.
During pregnancy
Heartburn and a heavy stomach trouble a great many pregnant women, and especially often in the second half of pregnancy. There are two reasons: hormonal changes relax the valve between oesophagus and stomach, and the growing womb pushes up the pressure inside the abdomen from below.
The same measures help — small frequent meals, an early supper, a raised bed head, avoiding trigger foods, loose clothing. Not every medicine is suitable in pregnancy, so even those sold without prescription are best chosen together with a doctor or pharmacist. Reassuringly, this kind of heartburn usually goes away by itself, and fairly quickly, after the birth. Severe pain in the upper abdomen in the second half of pregnancy is another matter, though, particularly alongside headache, swelling or disturbed vision: that is not the stomach, and it needs urgent contact with a doctor.
Online consultation
In an online consultation the doctor will take your picture apart piece by piece: exactly where the discomfort sits, whether it is linked to food and to which food, what happens at night and on bending, how long it has been going on, what you have already tried and with what result. They will check the warning signs separately — difficulty swallowing, weight loss, traces of blood, anaemia — and ask about your medicines, since the cause quite often turns out to be there. They will help you decide whether adjusting habits and choosing a remedy is enough, or whether it is time to look for Helicobacter and arrange an endoscopy, and they will explain how to prepare for the tests so that the result is not a false one.
This material is for information only and does not replace medical advice.
Consult with a doctor about Indigestion
Discuss your symptoms and possible next steps with a doctor online.
Online doctors for Indigestion
Discuss your symptoms and possible next steps for Indigestion with a doctor online.
