Indigestion (dyspepsia) is a general term for pain or discomfort felt in the stomach and under the ribs.
Heartburn is when acid moves up from the stomach into the gullet (oesophagus) and causes a burning pain behind your breastbone.
Indigestion and heartburn can occur together or on their own.
It's a common problem that affects most people at some point. In most cases it's mild and only occurs occasionally.
Symptoms of indigestion
As well as heartburn, other common symptoms of indigestion include:
- feeling uncomfortably full or bloated
- feeling sick
- belching or passing wind (flatulence)
- bringing up food or fluid from your stomach
These symptoms usually occur soon after eating or drinking, although there can sometimes be a delay between eating and getting indigestion.
What causes indigestion?
Indigestion is usually related to eating. When you eat, your stomach produces acid. The acid can sometimes irritate your stomach lining, the top part of the bowel, or the oesophagus.
This irritation can be painful and cause a burning sensation, particularly if the lining of your digestive system is overly sensitive to acid.
Your stomach can also stretch after eating a big meal, causing acid reflux, where the acid moves up into your oesophagus.
Indigestion can also be triggered or made worse by a number of other factors:
Medication
Some medicines, such as nitrates – taken to widen blood vessels – relax the ring of muscle between the oesophagus and stomach. This allows acid to leak back up.
Non-steroidal anti-inflammatory drugs (NSAIDs), such as aspirin and ibuprofen, can also affect your digestive tract and cause indigestion.
Don't take NSAIDs if you have stomach problems, such as a stomach ulcer, or you've had problems in the past. Children under 16 shouldn't take aspirin.
Obesity
If you're overweight or obese, you're more likely to get indigestion. This is because increased pressure inside your stomach, particularly after a large meal, can cause acid reflux.
Pregnancy
Indigestion in pregnancy is partly caused by hormonal changes, and by the growing womb pressing on your stomach in the later stages of pregnancy.
As many as 8 out of 10 women experience indigestion at some point during their pregnancy.
Smoking and alcohol
The chemicals inhaled in cigarette smoke may contribute to indigestion. They can cause the muscle between the oesophagus and stomach to relax, causing acid reflux.
Drinking excess amounts of alcohol can also increase your risk of getting indigestion. Alcohol causes your stomach to produce more acid than normal, which can irritate your stomach lining.
Read more about the risks of drinking too much alcohol.
Stress or anxiety
Stress or anxiety can sometimes contribute to the symptoms of indigestion. Find out about breathing exercises for stress.
Hiatus hernia
A hernia occurs when an internal part of the body pushes through a weakness in the surrounding muscle or tissue wall.
A hiatus hernia is where part of the stomach pushes up into the diaphragm, the sheet of muscle under your lungs. This can cause acid reflux.
Helicobacter pylori (H. pylori) infection
Helicobacter pylori infections are common. They sometimes lead to stomach ulcers, although in most cases they don't cause any symptoms at all.
Some people may get episodes of indigestion after having an H. pylori infection. In these cases, treating the infection with antibiotics will help.
Gastro-oesophageal reflux disease (GORD)
Gastro-oesophageal reflux disease (GORD) is a common condition and one of the main causes of recurring indigestion.
It occurs when the muscle between the oesophagus and stomach fails to prevent stomach acid rising into the oesophagus.
A small amount of acid reflux is normal and rarely causes problems. But in GORD a large amount of reflux causes the sensitive lining of your oesophagus to become inflamed.
This is caused by repeated irritation from stomach acid, and can cause heartburn, the sensation of bringing fluid back up, and painful swallowing.
Stomach ulcers
A stomach ulcer is an open sore that develops on the inside lining of your stomach (gastric ulcer) or small intestine (duodenal ulcer). Indigestion may be a symptom if you have a stomach ulcer.
Stomach ulcers form when stomach acid damages the lining in your stomach or duodenum wall. In most cases the lining is damaged as a result of an H. pylori infection.
Stomach cancer
In rare cases, recurring bouts of indigestion can be one of the symptoms of stomach cancer.
Cancerous cells in the stomach break down the protective lining, allowing acid to come into contact with the stomach wall.
When to see your GP
There's usually no need to seek medical advice for indigestion as it's often mild and infrequent and specialist treatment isn't required.
However, you should see your GP if you have recurring indigestion and any of the following apply:
- you're 55 years of age or over
- you've lost a lot of weight without meaning to
- you have difficulty swallowing (dysphagia)
- you have persistent vomiting
- you have iron deficiency anaemia
- you have a lump in your stomach
- you have blood in your vomit or blood in your stools
These symptoms may be a sign of a more serious underlying health problem, such as a stomach ulcer or stomach cancer.
Also see your GP if you get indigestion regularly, if it causes you severe pain or discomfort, or if your regular anti-reflux remedies stop working.
Your GP will ask you about your symptoms and:
- any other symptoms you have that may indicate an underlying health condition
- any medication you're taking – as some medications can cause indigestion
- your lifestyle – some lifestyle factors, such as smoking, drinking alcohol or being overweight, can cause indigestion
Your GP may also press gently on different areas of your stomach to see if this is painful and whether any of your internal organs are swollen.
Further investigations
Depending on your symptoms, your GP may want to investigate further.
This is because indigestion can sometimes be a symptom of an underlying condition, such as a Helicobacter pylori (H. pylori) bacterial infection, a stomach ulcer, or stomach cancer.
Your GP may refer you for a procedure called an endoscopy to rule out a more serious cause of your indigestion.
During an endoscopy, a thin, flexible tube with a light and camera at one end called an endoscope is used to examine the inside of your body.
Taking certain medicines for indigestion can hide some of the problems that could otherwise be spotted during an endoscopy.
This means that for at least two weeks before having an endoscopy you'll need to stop taking proton pump inhibitors (PPIs) and H2-receptor antagonists.
Your GP may also recommend changing other medications that may be causing your indigestion.
However, you should only stop taking medication if your GP or another healthcare professional in charge of your care advises you to do so.
Diagnosing H. pylori infection
If your GP thinks your symptoms may be caused by an H. pylori infection, you may need to have a test for it.
This may be a:
- stool antigen test – where a pea-sized stool sample is tested for H. pylori bacteria
- breath test
- blood test – a blood sample will be tested for antibodies to H. pylori bacteria
Antibiotics and PPIs can affect the results of a urea breath test or stool antigen test.
These tests may therefore need to be delayed until two weeks after you last used a PPI, and four weeks after you last used an antibiotic.
Diagnosing other conditions
You may need further tests to rule out other underlying conditions that could be causing your indigestion symptoms.
For example, abdominal pain and discomfort can be caused by conditions that affect the bile ducts in your liver.
Bile ducts are tubes that carry bile from the liver to the gallbladder and bowel. Bile is a digestive fluid that breaks down fats, and the gallbladder holds bile.
Your GP may suggest you have a liver function test, a blood test used to assess how well your liver is working.
You may also need to have an abdominal ultrasound scan, which uses high-frequency sound waves to create an image of the inside of your body.
Treating indigestion
Treatment for indigestion will vary depending on what's causing it and how severe your symptoms are.
Most people are able to manage their indigestion by making simple diet and lifestyle changes, or taking medication such as antacids.
See treating GORD if you've been diagnosed with gastro-oesophageal reflux disease (GORD). See treating a stomach ulcer if you've been diagnosed with a stomach ulcer.
Diet and lifestyle changes
It may be possible to ease your indigestion symptoms by making a few simple changes to your diet and lifestyle, such as those discussed below.
Losing weight can help if you're overweight. It's important to lose weight safely and steadily through regular exercise and by eating a healthy, balanced diet.
Avoid foods that seem to make your indigestion worse, such as rich, spicy and fatty foods. You should also cut down on caffeinated drinks, such as tea, coffee and cola, as well as alcohol.
Smoking can also contribute to indigestion, so speak to your GP or pharmacist about giving up smoking if you smoke. You can also call the NHS Stop Smoking Helpline on 0300 123 1044.
If you tend to experience the symptoms of indigestion at night, avoid eating for three to four hours before you go to bed.
Going to bed with a full stomach means there's an increased risk that acid in your stomach will be forced up into your oesophagus while you're lying down.
When you go to bed, prop your head and shoulders up with a couple of pillows, or raise the head of your bed by a few inches by putting something underneath the mattress.
The slight slope should help prevent stomach acid moving up into your oesophagus while you're asleep.
Changing medication
If your GP thinks the medication you're taking could be contributing to your indigestion, they may recommend changing it.
Where possible, your GP will prescribe an alternative medication that won't cause indigestion.
Immediate indigestion relief
Antacid medicines and alginates can be recommended or prescribed by your GP for immediate relief.
Antacids
Antacids are a type of medicine that can provide immediate relief for mild to moderate symptoms of indigestion.
They neutralise the acid in your stomach, making it less acidic, so it doesn't irritate the lining of your digestive system.
Antacids are available in tablet and liquid form. You can buy them over the counter from most pharmacies without a prescription.
The effect of an antacid only lasts for a few hours at a time, so you may need to take more than one dose. Always follow the instructions on the packet to ensure you don't take too much.
It's best to take antacids when you're expecting symptoms of indigestion, or when they start to occur, such as after meals or at bedtime. This is because antacids stay in your stomach for longer at these times and have more time to work.
For example, if you take an antacid at the same time as eating a meal, it can work for up to three hours. In comparison, if you take an antacid on an empty stomach, it may only work for 20 to 60 minutes.
Read more about considerations when using antacids, including possible interactions with other medicines and side effects.
Alginates
Some antacids also contain a medicine called an alginate. This helps relieve indigestion caused by acid reflux, when stomach acid leaks back up into the oesophagus, irritating its lining.
Alginates form a foam barrier that floats on the surface of your stomach contents, keeping stomach acid in your stomach and away from your oesophagus.
Your GP may recommend taking an antacid that contains an alginate if you experience symptoms of acid reflux or if you have GORD.
Antacids containing alginates should be taken after eating as this helps the medicine stay in your stomach for longer. Taking alginates on an empty stomach will result in them leaving your stomach too quickly for them to be effective.
Persistent indigestion
If you have persistent or recurring indigestion, treatment with antacids and alginates may not be effective enough to control your symptoms.
Your GP may recommend a different type of medication, which will be prescribed at the lowest possible dose to control your symptoms.
Possible medications include proton pump inhibitors (PPIs) and H2-receptor antagonists.
Proton pump inhibitors (PPIs)
Proton pump inhibitors (PPIs) restrict the acid produced in your stomach. They are taken as tablets and are usually only available on prescription.
If you're over 18, you can buy some types of PPIs over the counter in pharmacies, but these should only be used for short-term treatment. See your GP if your indigestion is persistent.
PPIs may enhance the effect of certain medicines. If you're prescribed a PPI, your progress will be closely monitored if you're also taking other medication, such as:
If you're referred for an endoscopy, you'll need to stop taking a PPI at least 14 days before the procedure. This is because PPIs can hide some of the problems that would otherwise be spotted during the endoscopy.
PPIs can sometimes cause side effects, but they're usually mild and reversible.
Side effects may include:
- headaches
- diarrhoea
- constipation
- feeling sick
- vomiting
- flatulence
- stomach pain
- dizziness
- skin rashes
H2-receptor antagonists
H2-receptor antagonists are another type of medication that your GP may suggest if antacids, alginates and PPIs haven't been effective at controlling your indigestion.
There are four H2-receptor antagonists:
- cimetidine
- famotidine
- nizatidine
- ranitidine
These medicines work by lowering the acidity level in your stomach.
Your GP may prescribe any one of these four H2-receptor antagonists, although famotidine and ranitidine are available to buy over the counter in pharmacies. H2-receptor antagonists are taken either in tablet or liquid form.
As with PPIs, you'll need to stop taking H2-receptor antagonists at least 14 days before having an endoscopy. This is because they can hide some of the problems that could otherwise be spotted during the procedure.
Helicobacter pylori (H. pylori) infection
If your indigestion symptoms are caused by an H. pylori infection, you'll need treatment to clear the infection from your stomach.
This should help relieve your indigestion, as the H. pylori bacteria will no longer be increasing the amount of acid in your stomach.
H. pylori infection is usually treated using triple therapy, where treatment involves taking three different medications.
Your GP will prescribe a course of treatment consisting of:
- two different antibiotics
- a PPI
You'll need to take these medicines twice a day for seven days. You must follow the dosage instructions closely to ensure the triple therapy is effective.
One course of triple therapy is effective at clearing an H. pylori infection in up to 85% of cases. However, you may need more than one course of treatment if it doesn't clear the infection the first time.
Complications of indigestion
In some cases, severe indigestion can cause complications.
Oesophageal stricture
If the lining of the oesophagus is severely irritated over time by acid reflux, the oesophagus may become scarred.
The scarring can eventually lead to your oesophagus becoming narrow and constricted – an oesophageal stricture.
If you have oesophageal stricture, you may have symptoms such as:
- difficulty swallowing (dysphagia)
- food becoming lodged in your throat
- chest pain
Surgery to widen the oesophagus is often needed to treat oesophageal stricture.
Pyloric stenosis
Like oesophageal stricture, pyloric stenosis is caused by long-term irritation of the lining of your digestive system by stomach acid.
Pyloric stenosis occurs when the passage between your stomach and your small intestine – the pylorus – becomes scarred and narrowed. This causes vomiting and prevents any food you eat being properly digested.
In most cases, pyloric stenosis is treated using surgery to return the pylorus to its proper width.
Barrett's oesophagus
Repeated episodes of gastro-oesophageal reflux disease (GORD) can lead to changes in the cells that line your lower oesophagus. This is a condition known as Barrett's oesophagus.
It's estimated 1 in 10 people with GORD will develop Barrett's oesophagus. Most cases affect people aged 50 to 70 – the average age at diagnosis is 62.
Barrett's oesophagus doesn't usually cause noticeable symptoms other than those associated with GORD.
However, it is a pre-cancerous condition. This means that while the cell changes aren't cancerous, there's a small risk they could develop into "full blown" cancer in the future, resulting in oesophageal cancer.
