What is indigestion?

This article, written by an expert in gastroenterology, discusses the symptoms, causes, and treatments for indigestion. This is a very common condition affecting people of all ages. This article will help those suffering from persistent symptoms who would like to know how indigestion can be eased.

Indigestion

Indigestion, is a symptom related to the gullet or stomach that is triggered by food/liquid and usually occurs soon after food has been consumed. It is an extremely common condition affecting all ages.

Indigestion means different things to different people. I always specifically ask patients to describe what he/she means by ‘indigestion’ or ‘dyspepsia’ or ‘heartburn’ and the symptoms it causes them.

Indigestion causes

The oesophagus is a long pipe surrounded by muscle and filled with nerve endings. Normal muscle contractions (peristalsis) propel food/fluid down the gullet and through a valve into the stomach. Sometimes this valve can be weak meaning that fluid and acid in the stomach can flow back up into the gullet causing pain. Air can also reflux causing belching. This is normal after meals as it prevents the stomach from distending excessively. This stops the feeling of being bloated after meals.

Sometimes the symptoms of indigestion can be triggered by emotional or physical stress, and non-steroidal anti-inflammatory drugs (NSAIDs), such as aspirin, ibuprofen or similar tablets, can make symptoms even worse.

Indigestion pain and other symptoms of indigestion

Common symptoms of indigestion include:

• Heartburn/chest pain/back pain

• Belching

• Dyspepsia (discomfort in the chest/upper abdominal pain)

• Bloating/distension

• Getting full easily

Heartburn

Heartburn is the result of the reflux of acid up into your chest, the symptom of which is a burning feeling. This pain usually feels like burning at the front of your chest, but it can also occur in the centre of your back (between the shoulder blades). The term heartburn is often used interchangeably with acid reflux or gastro-oesophageal reflux disease (GORD), although in GORD there may be underlying inflammation of the oesophagus (oesophagitis).

Read the article heartburn: causes and remedies for a more in-depth look at heartburn and how it can be treated.

Belching/bloating/wind

Are you:

• A fast eater? – STOP – you will swallow air, which must either be belched up or be passed out your lower end!
• A gum chewer? – STOP – with constant gum chewing, air gets swallowed with the saliva leading to bloating and belching.
• A lover of fizzy drinks? – STOP – carbonated drinks lead to belching and bloating.
• Eating too much fibre? – STOP – this can lead to excess fermentation of fibre in your gut and bloating (see my article on Irritable Bowel Syndrome).

If the answer is yes to any of these questions – cut back!

Dyspepsia

The term ‘dyspepsia’ has been defined as a discomfort in the epigastrium (upper abdomen in the midline) after meals. This may also be associated with early satiety (getting full up easily) or a feeling of bloating. There may be associated nausea and belching.

The rule of 'C'

There is no perfect diet that will treat everyone, but over the years I have realised that the following foods make symptoms of heartburn/acid indigestion much worse. I call this the rule of ‘C’ – cut the following foods, drinks and smokes out of your diet because they tend to make the valve between the gullet and stomach more leaky, triggering reflux.

• Cigarettes/cigars
• Coffee
• Caffeine-containing drinks
• Cheese
• Chocolate
• Cream (including ice cream)
• Creamy desserts
• Citrus
• Cake
• Coke
• Chips/crisps (by which I mean fat)
• Champagne/Chablis (by which I mean alcohol)
• Curry

What happens if your indigestion symptoms persist?

Most of us have suffered with indigestion at some point, but persistent symptoms should be reviewed by your GP. If you have already followed the lifestyle advice above, then your GP might want to test you for an infection known as Helicobacter pylori. This bug can live long-term in our stomachs causing indigestion and ulcers. It is treated with a 1 week course of antibiotics. If you don’t have the H Pylori infection then your GP might treat you with tablets or refer you to a gastroenterologist.

You should seek help if your symptoms aren't getting better with dietary changes or through the use of simple antacids. If symptoms continue following treatment from your GP, such as taking PPIs, then the GP may consider referring you for an endoscopy to check the diagnosis.

If you have indigestion and one of the following conditions, you should seek medical help:

• Anaemia

• Weight loss

• Loss of appetite

• Vomiting

• Recent onset of progressive symptoms

• Vomiting blood

• Difficulty swallowing.

If you have new symptoms and you’re over the age of 55 then you should consider going to your GP.

What might happen if you meet me?

1.  We will discuss your symptoms and focus on diet in particular.

2.  We will agree a treatment strategy.

3.  If your symptoms are new/changing I might consider blood tests for protein level, markers of inflammation, a blood count, and a wheat allergy test.

4.   If your symptoms warrant it, then I will recommend a gastroscopy (also known as an endoscopy). A gastroscopy is an examination that directly views your gullet, stomach and duodenum using a thin flexible fibre-optic endoscope. If required, tissue samples can be taken and a biopsy performed to look for H pylori. The test is performed either under sedation to relax you or while you are awake, and you can decide which you would prefer. The examination is done as a day case procedure. You will come into hospital and go home a few hours later.

Possible endoscopy findings include:

• Inflammation of the gullet

• Stomach ulcers

• Inflammation of the stomach or duodenum

• Cancer (this is an incredibly rare diagnosis and rarely presents with just indigestion)

• A normal examination – this is good news and in many people with indigestion, the examination is structurally normal. In this case we can concentrate on treating your symptoms with a combination of diet and medication.

Summary

Indigestion symptoms can be troublesome but are treatable and with the correct review of your diet it should be possible to help your symptoms get better. If you are concerned about your symptoms and unsure whether medical intervention is required, then you should discuss this with your GP.  The National Institute for Healthcare and Care Excellence have released guidance for adults with indigestion.

Sources of further information

British Society of Gastroenterology - Indigestion

CORE - Patient leaflet: indigestion (charity supporting research into gut and liver disease)

Hertfordshire Gastroenterology

For further information on the author of this article, Consultant Gastroenterologist, Dr Simon Greenfield, please click here.