Indigestion & Heartburn
What are the symptoms of this condition?
These conditions are felt as a burning pain and discomfort in the stomach, upper abdomen, or central chest area. There may also be the sensation of trapped wind, and the need to burp in order to relieve this; often these symptoms develop a short time after eating a meal.Indigestion is felt as a burning within the stomach, whereas heartburn is caused by a reflux of stomach acid into the oesophagus (gullet) and the pain is felt higher up in the chest, hence the name.
What is the cause of the condition?
On most occasions, indigestion or heartburn is caused by over-indulgence in either food or alcohol or both, although there are a number of other possible causes.Indigestion is a consequence of the normal process of acid production in the stomach. Acid is a necessary part of the digestive process, and is produced by cells inside the stomach lining. Any food being eaten passes into the stomach from the oesophagus (gullet); the food is then broken down into a more liquid state, by a combination of the stomach acid and contractions of the muscles in the wall of the stomach, which 'churn' the food and ensure that it is thoroughly mixed. This is a relatively slow process and may take several hours, depending on the nature of the stomach contents. Once the acid has been mixed with the food, it is then passed into the small intestine for further digestion, and absorption of essential nutrients.
The quantity of acid being released into the stomach is affected by the quantity and type of food eaten - although acid release can also be triggered just by the sight or the smell of food.
Large quantities of slowly digesting food in the stomach may trigger the symptoms of indigestion. The bulk stretches the stomach wall, causing a feeling of fullness, and the churning of the stomach muscles can cause discomfort.
When acid from the stomach leaks back up into the oesophagus, this causes the sensation of heartburn; while the stomach is designed to hold acid, the oesophagus is not, and any acid which travels upwards into the oesophagus will cause irritation, which is commonly experienced as a burning pain in the chest. This leakage of stomach contents can be caused by several factors, including a weakness of the muscular valve which holds the top of the stomach shut during digestion (the oesophageal sphincter).
There are several underlying causes of indigestion, more details of which can be found below:
Smoking:
Smokers are more prone to heartburn and indigestion; chemicals in tobacco are absorbed into the saliva and carried to the stomach, where they can increase the amount of stomach acid produced, slow the rate of stomach emptying, and prevent the oesophageal sphincter from working properly.Dietary factors:
over-indulgence, alcohol, chocolate, and some highly spiced foods can stimulate extra acid production. Rushed meals (where the food is not chewed properly before being swallowed) are more difficult for the stomach to break down, and so may cause indigestion symptoms.Pregnancy:
Pregnancy is a common cause of indigestion and heartburn; the digestive discomfort results from pressure on the stomach from the growing baby. Also, iron supplements taken during pregnancy can cause indigestion.Overweight:
Being overweight can make you more prone to indigestion and heartburn, because of the extra pressure on the stomach that can push the stomach contents back into the oesophagus.Medicines:
A number of medicines can irritate the stomach lining, causing indigestion and, in extreme cases, bleeding in the stomach. Aspirin and related anti-inflammatory preparations (including ibuprofen and many prescription-only medicines) are known for this potential adverse effect, and should be avoided if you are prone to indigestion. Advice should be obtained from the Pharmacy2U pharmacist or your own doctor before taking these types of drugs if you have had stomach ulcers in the past or a history of indigestion. Other drugs can also cause indigestion; steroid tablets (taken by some asthmatics to control symptoms, for example), may act as an irritant to the stomach.The symptoms of indigestion and heartburn may indicate a more serious underlying condition - especially when it presents for the first time in those aged over forty. If this is the case, or if you suffer from attacks of indigestion or heartburn which do not respond to self-treatment or non-prescription remedies, you should report this to your doctor.
What complications might occur?
The symptoms of indigestion and heartburn are usually short-lived and self-limiting - that is, the symptoms will resolve themselves given time. If the digestive discomfort is due to more than simple indigestion, then complications may arise; for example, if a stomach ulcer is causing the symptoms, then there may also be bleeding inside the stomach, which will not be directly noticeable, but it could be diagnosed by finding traces of blood in the stools.Larger amounts of blood will visibly affect the stools, making them black and tarry in appearance. Should you notice this it is important you see your doctor as soon as possible. Very severe pain, possibly accompanied by a rapid loss of weight, can also indicate a more serious condition and must be investigated by your doctor as soon as possible.
What can I do to treat myself?
If there is no underlying problem causing the symptoms, there are a number of self-help measures you can try to ease the symptoms and prevent them from recurring.Indigestion and heartburn are commonly the result of over-eating, eating too quickly, or consuming too much alcohol - alcohol can be very irritating to the stomach.
The solution is to adopt eating habits which are less upsetting to the stomach. Take meals more regularly, and in smaller amounts; chew the food thoroughly before swallowing; and avoid, if at all possible, foods that you know are likely to cause indigestion. Drink alcohol in moderation.
Smoking may cause indigestion and can make you prone to digestive upsets. If you feel that your discomfort is related to smoking, this is one more good reason to kick the habit - ask the Pharmacy2U pharmacist for advice on how to stop smoking, if you need further support.
In addition to these simple measures, there are several non-prescription medicines available from Pharmacy2U which may help your symptoms, which are discussed in detail in the next section. Advice can be obtained from the Pharmacy2U pharmacist if you are unsure about which product is most suitable for you.
What treatments are available for me to purchase?
Indigestion should only be an infrequent problem - if you suffer from regular or persistent indigestion, you should talk to your doctor who will investigate further.There are four main groups of indigestion remedies: antacids which neutralise the stomach acid, "H2 antagonists" which reduce the amount of stomach acid being produced, deflatulents which help to release excess gas, and alginates which help to prevent heartburn.
Antacids
These usually consist of salts of aluminium and magnesium,
calcium carbonate and sodium bicarbonate. They act by neutralising
some of the stomach acid, making it less acidic and so less
irritating to the stomach lining. This effect is relatively
short-lived, as the antacids are flushed out of the stomach
and more acid is produced. Magnesium salts tend to cause mild
diarrhoea as a side effect, and aluminium salts may cause
constipation. The two ingredients are often combined to cancel
out these effects. Some antacids have a high sodium content
and are unsuitable for people with high blood pressure. Antacids
are useful remedies for occasional attacks of indigestion,
and may be taken after meals as preventatives. They are available
as liquids or tablets. Some examples of antacids are Rennie,
Rap-eze, Bisodol and Dijex.
H2 antagonists
These act by blocking the formation of stomach acid. They
are more powerful than the simple antacids and have a longer
lasting effect. The ingredients found in non-prescription
preparations are cimetidine (found in Tagamet), ranitidine
(Zantac) and famotidine (Pepcid). There are a number of restrictions
on the use of these products, and the individual product information
should be consulted before taking them; they should not be
used for longer than two weeks without consulting a doctor,
as they will continue to mask your symptoms, which may need
treating in a different way.
Deflatulents
These help to release trapped wind and aid burping. The ingredients
include peppermint oil and dimethicone, and these are often
combined with antacids. Products containing deflatulents include
Asilone Windcheaters and Rennie Deflatine.
Alginates
These float on top of the stomach contents forming a raft
which prevents acid escaping up into the oesophagus, thus
preventing the symptoms of heartburn. On their own, alginates
are less effective for treating simple indigestion, however
many products also contain antacids. Products containing alginates
include Gaviscon and Algicon.
To view the full list of indigestion remedies available from Pharmacy2U click here.
For advice or help in selecting an appropriate indigestion remedy please consult the Pharmacy2U pharmacist.
What treatments are available from my doctor?
Many treatments available from your doctor are similar to those available to purchase without a prescription. Your doctor may prescribe more powerful medicines to prevent the stomach from producing excess acid, or other medicines to treat a Helicobacter pylori infection, if this is shown to be present - see below.What additional investigations might be needed?
Persistent indigestion which is not responding well to treatment will need to be referred to your doctor. He or she may decide that investigations of the stomach are needed; these may involve taking X-rays of the stomach after it has been coated with barium (a substance that X-rays cannot pass through) to show up the stomach lining, which will highlight any damage, or an examination of the stomach using an endoscope (a flexible tube that can be passed into the stomach and which allows the doctor to look at the stomach lining).In some cases, the doctor may decide to test for the presence of a stomach infection caused by a bacteria called Helicobacter pylori, which irritates the stomach lining into producing more acid than is needed. If this infection is shown to be present, it can be treated with a high degree of success using a combination of antibiotics and powerful medicines to stop the stomach producing acid.
Any other information I should have?
Indigestion or heartburn is normally a transient problem and can easily be corrected, either by changing dietary and eating habits, or by the use of a suitable remedy. However, it can sometimes be a symptom of a more serious condition, especially if it occurs for the first time in those aged over 40, or if it does not respond well to self-treatment. If you have any doubts or concerns about your symptoms, please consult your doctor or the Pharmacy2U pharmacist.Email Newsletter
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