IndigestionSee all parts of this guide Hide guide parts
Indigestion can be pain or discomfort in your upper abdomen (dyspepsia) or burning pain behind the breastbone (heartburn).
Dyspepsia and heartburn may occur together or on their own. Symptoms usually appear soon after eating or drinking.
Common associated symptoms include:
- feeling full or bloated
- feeling sick (nausea)
- bringing up (regurgitating) fluid or food into the gullet (oesophagus)
Indigestion is a common problem that affects many people, but in most cases it's mild and only occurs occasionally.
Read more about the symptoms of indigestion.
Why it happens
Indigestion may be caused by stomach acid coming into contact with the sensitive, protective lining of the digestive system (mucosa). The stomach acid breaks down the lining, leading to irritation and inflammation, which can be painful.
The majority of people with indigestion don't have inflammation in their digestive system. Therefore, their symptoms are thought to be caused by increased sensitivity of the mucosa (to acidity or stretching).
In most cases indigestion is related to eating, although it can be triggered by other factors such as smoking, drinking, alcohol, pregnancy, stress or taking certain medications.
Read more about the causes of indigestion.
Treating indigestion at home
Most people are able to treat indigestion with simple changes to their diet and lifestyle, or with a number of different medications, such as antacids.
Read more about the treatment of indigestion.
Very rarely, a serious underlying health condition is the cause of indigestion. If this is suspected, then further investigation such as an endoscopy will be required (see below).
When to get professional advice
Pharmacy First Scotland: Indigestion treatment from your pharmacy
If you have symptoms of indigestion you can get treatment directly from a pharmacy. Find your local pharmacy on Scotland's Service Directory.
Most people will not need to seek medical advice for their indigestion. However, your pharmacist may advise you see your GP if you have recurring indigestion and any of the following apply:
- you are 55 years old or over
- you have lost a lot of weight without meaning to
- you have increasing 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
This is because these symptoms may be a sign of an underlying health condition, such as a stomach ulcer or stomach cancer. You may need to be referred for an endoscopy to rule out any serious cause.
An endoscopy is a procedure where the inside of the body is examined using an endoscope (a thin, flexible tube that has a light and camera on one end).
Severe indigestion can cause long-term problems with parts of your digestive tract, such as scarring of the oesophagus or the passage from your stomach. Read more about the possible complications of severe indigestion.
Symptoms of indigestion
The main symptom of indigestion is pain or a feeling of discomfort in your upper abdomen (dyspepsia). People often experience the associated feeling of burning behind the breastbone (heartburn), but this may occur on its own.
These symptoms usually come on soon after eating or drinking, although there can sometimes be a delay between eating a meal and experiencing indigestion.
Heartburn is caused by acid that passes from your stomach into your gullet (oesophagus).
If you have indigestion, you may also have symptoms such as:
- feeling uncomfortably full or heavy
- belching or flatulence(passing wind)
- bringing food or fluid back up from your stomach (reflux)
- feeling sick (nausea)
Causes of indigestion
Indigestion has a number of different causes, but it's rarely due to a serious, underlying condition.
It's normal for your stomach to produce acid, but sometimes this acid can irritate the lining of your stomach, the top part of your bowel (duodenum) or your gullet (oesophagus).
This irritation can be painful and often causes a burning sensation. Indigestion may also be due to the lining of your digestive system being overly sensitive to acid, or the "stretching" caused by eating.
Indigestion can also be triggered or made worse by other factors. Some of these are explained below.
You may have indigestion if you take certain types of medication. Some medicines, such as nitrates (taken to widen your blood vessels) relax the oesophageal sphincter (ring of muscle between your oesophagus and your stomach), which allows acid to leak back up.
Other medicines, such as non-steroidal anti-inflammatory drugs (NSAIDs), can affect your digestive tract and cause indigestion.
Do not take NSAIDs, such as aspirin and ibuprofen, if you have stomach problems, such as a stomach ulcer, or have had this in the past. Children under 16 years of age should not take aspirin.
Never stop taking a prescribed medication unless you are told to do so by your GP or another qualified healthcare professional who is responsible for your care.
If you are very overweight, you are more likely to experience indigestion because of increased pressure inside your stomach (abdomen).
The increased pressure, particularly after a large meal, may lead to acid reflux into the oesophagus.
Stress or anxiety
If you regularly experience feelings of stress or anxiety, this can contribute to symptoms of indigestion.
Read some relaxation tips to relieve stress.
A hernia occurs when an internal part of the body, such as an organ, pushes through a weakness in the surrounding muscle or tissue wall.
A hiatus hernia occurs when part of your stomach pushes up into your diaphragm (the sheet of muscle under your lungs). It may partially block refluxed stomach acid clearing from your oesophagus, leading to heartburn.
Helicobacter pylori infection
Helicobacter infection is very common. It may lead to stomach ulcers or, rarely, stomach cancer. In most cases, however, it does not cause any symptoms at all.
Some people may get bouts of indigestion from helicobacter infection and, in these cases, getting rid of the bug with antibiotics (eradication) will help. However, many cases of indigestion are not caused by helicobacter, and in these cases eradication will not get rid of symptoms.
Gastro-oesophageal reflux disease (GORD)
Gastro-oesophageal reflux disease (GORD) is a common condition and one of the main causes of recurring indigestion. It's caused by acid reflux, which occurs when the oesophageal sphincter fails to prevent stomach acid from moving back up into your oesophagus.
A little bit of acid reflux is normal and rarely cause any symptoms. It becomes GORD when large amounts of reflux occur, and the sensitive lining of your oesophagus may get inflamed by repeated irritation from stomach acid. This can lead to heartburn, the sensation of regurgitation or painful swallowing.
A stomach ulcer is an open sore that develops on the inside lining of your stomach (a gastric ulcer) or small intestine (a duodenal ulcer). If you have a stomach ulcer, you may have indigestion as a symptom.
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 (see above).
In rare cases, recurring bouts of indigestion can be a symptom of stomach cancer.
Cancer cells in your stomach break down the protective lining, allowing acid to come into contact with your stomach wall.
For most people, indigestion (dyspepsia) is mild and infrequent, and does not require treatment from a healthcare professional.
However, if you have indigestion regularly, or if it causes you severe pain or discomfort, see your pharmacist.
They will ask about your indigestion symptoms, as well as:
- any other symptoms you have – which may indicate an underlying health condition
- any medication you are taking – as some medications can cause indigestion
- your lifestyle – as some lifestyle factors, such as smoking, drinking alcohol or being overweight, can cause indigestion
Depending on the type of indigestion symptoms you have, your pharmacist may recommend you see your GP to investigate your condition further. This is because indigestion can sometimes be a symptom of an underlying condition or health problem, such as a Helicobacter pylori (H pylori) bacterial infection.
Details of some of the further investigations you may have are outlined below.
You may be referred to hospital to have an endoscopy.
An endoscopy is a procedure used to examine the inside of your body using an endoscope – a thin, flexible tube, about the width of your little finger, with a light and a camera on one end. The camera is used to relay images of the inside of your body to a TV monitor.
An endoscopy is not often needed to diagnose indigestion, but your GP may suggest that you have one if:
- they need to examine the inside of your abdomen in more detail
- you have had treatment for indigestion that has not worked
- you have any serious symptoms of indigestion
Read more about having an endoscopy.
Taking certain medicines for indigestion can hide some of the problems that could otherwise be spotted during an endoscopy. Therefore, for at least two weeks before your endoscopy, you will need to stop taking proton pump inhibitors (PPIs) and H2-receptor antagonists.
Read more about treatments for indigestion.
Your GP may also recommend changing other medications that may be causing your indigestion. However, only stop taking medication if you are advised to do so by your GP or another healthcare professional responsible for your care.
Diagnosing H pylori infection
If your GP thinks that your symptoms may be due to an infection with H pylori bacteria, you may need to have a test for it, such as:
- a stool antigen test – a pea-sized stool (faeces) sample will be tested for H pylori bacteria
- a breath test
- a blood test– a blood sample will be tested for antibodies to H pylori bacteria (antibodies are proteins produced by the body to fight infection)
Antibiotics and PPIs can affect the results of a urea breath test or a stool antigen test. Therefore, these tests may 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
If your GP thinks that your indigestion symptoms may be caused by another underlying medical condition, you may need to have some further tests to rule this out.
For example, abdominal pain and discomfort can also be caused by conditions affecting the bile ducts in your liver. Your bile ducts are a series of tubes that carry bile (fluid used by the digestive system to break down fats) from the liver to the gallbladder (a pouch that holds bile) and the bowel. If your GP thinks that you may have such a condition, they may suggest you have a liver function test, which is a type of blood test used to assess how well your liver is working.
You may also need to have an abdominal ultrasound. An ultrasound scan uses high-frequency sound waves to create an image of the inside of your body.
Treatment for indigestion (dyspepsia) will vary, depending on what is causing it and how severe your symptoms are.
If you have been diagnosed with an underlying health condition, you may want to read our information on:
Diet and lifestyle changes
If you only have indigestion occasionally, you may not need to see your pharmacist or GP for treatment. It may be possible to ease your symptoms by making a few simple changes to your diet and lifestyle, summarised below.
Being overweight puts more pressure on your stomach, making it easier for stomach acid to be pushed back up into your gullet (oesophagus). This is known as acid reflux, and is one of the most common causes of indigestion.
If you are overweight or obese, it is important to lose weight safely and steadily through regular exercise and by eating a healthy, balanced diet. Read advice on losing weight.
If you smoke, the chemicals you inhale in cigarette smoke may contribute to your indigestion. These chemicals can cause the ring of muscle that separates your oesophagus from your stomach to relax, causing acid reflux.
Read more about quitting smoking, or speak to your GP or pharmacist. You can also call the Quit Your Way Scotland service on 0800 84 84 84 (8.00am to 10.00pm, every day).
Diet and alcohol
Make a note of any particular food or drink that seems to make your indigestion worse, and avoid these if possible. This may mean:
- eating less rich, spicy and fatty foods
- cutting down on drinks that contain caffeine – such as tea, coffee and cola
- avoiding or cutting down on alcohol
If you tend to experience indigestion symptoms at night, avoid eating for three to four hours before you go to bed. Going to bed with a full stomach means there is an increased risk that acid in your stomach will be forced up into your oesophagus while you are lying down.
When you go to bed, use a couple of pillows to prop your head and shoulders up or, ideally, raise the head of your bed by a few inches by putting something underneath the mattress. The slight slope that is created should help to prevent stomach acid moving up into your oesophagus while you are asleep.
Stress or anxiety
If you regularly experience feelings of stress or anxiety, this can contribute to symptoms of indigestion.
Read some relaxation tips to relieve stress.
Changing current medication
Your pharmacist may recommend making changes to your current medication if they think it could be contributing to your indigestion.
As long as it is safe to do so, you may need to stop taking certain medications, such as aspirin or ibuprofen. Where required, your pharmacist may advise you see your GP to prescribe an alternative medication that will not cause indigestion. However, never stop taking any medication without consulting your pharmacist or GP first.
Immediate indigestion relief
If you have indigestion that requires immediate relief, your pharmacist can advise you about the best way to treat this. As well as lifestyle changes and reviewing your current medication, your GP may prescribe or recommend:
- antacid medicines
These are described in more detail below.
Antacids are a type of medicine that can provide immediate relief for mild to moderate symptoms of indigestion. They work by neutralising the acid in your stomach (making it less acidic), so that it no longer irritates 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 do not take too much.
It is best to take antacids when you are expecting symptoms of indigestion, or when they start to occur, such as:
- after meals
- 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 antacids, including possible interactions with other medicines and side effects.
Some antacids also contain a medicine called an alginate. This helps relieve indigestion caused by acid reflux.
Acid reflux occurs when stomach acid leaks back up into your oesophagus and irritates 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 pharmacist may suggest that you take an antacid that contains an alginate if you experience symptoms of acid reflux or if you have GORD.
Take antacids containing alginates after eating, because this helps the medicine stay in your stomach for longer. If you take alginates on an empty stomach, they will leave your stomach too quickly to be effective.
Treating persistent indigestion
If you have indigestion that is persistent or recurring, treatment with antacids and alginates may not be effective enough to control your symptoms. Your pharmacist 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)
- H2-receptor antagonists
These are described in more detail below. Your pharmacist may advise you to see your GP who may also test you for the Helicobacter pylori (H pylori) bacteria (see Indigestion – diagnosis) and prescribe treatment for this if necessary.
Proton pump inhibitors (PPIs)
PPIs restrict the acid produced in your stomach.
The medication is taken as tablets and if you are over 18, you can buy some types of PPIs over the counter in pharmacies, but these should only be used for short-term treatment. PPIs may enhance the effect of certain medicines. If you are prescribed a PPI, your progress will be monitored if you are also taking other medicines, such as:
- warfarin – a medicine that stops the blood clotting
- phenytoin – a medicine to treat epilepsy
If your ingestion is persistent, your pharmacist might advise you to see your GP.
If your GP refers you for an endoscopy (a procedure that allows a surgeon to see inside your abdomen), you will 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. However, they are usually mild and reversible. These side effects may include:
- feeling sick (nausea)
- stomach pain
- skin rashes
H2-receptor antagonists are another type of medication that your pharmacist or GP may suggest if antacids, alginates and PPIs have not been effective in controlling your indigestion. There are four H2-receptor antagonists:
These medicines work by lowering the acidity level in your stomach.
Your GP may prescribe any one of these four H2-receptor antagonists, although ranitidine is available from pharmacies under the Pharmacy First Scotland service. H2-receptor antagonists are usually taken in tablet form.
As with PPIs, you will need to stop taking H2-receptor antagonists at least 14 days before having an endoscopy if this has been arranged through your GP. This is because they can hide some of the problems that could otherwise be spotted during the endoscopy.
Helicobacter pylori (H pylori) infection
If your indigestion symptoms are caused by an infection with H pylori bacteria, you will need to have treatment to clear the infection from your stomach. This should help relieve your indigestion, because 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 (treatment with three different medications). Your GP will prescribe a course of treatment containing:
- two different antibiotics (medicines to treat infections that are caused by bacteria)
- a PPI
You will need to take these medicines twice a day for seven days. You must follow the dosage instructions closely to ensure that the triple therapy is effective.
In up to 85% of cases, one course of triple therapy is effective in clearing an H pylori infection. However, you may need to have more than one course of treatment if it does not clear the infection the first time.
Complications of indigestion
In most cases, indigestion (dyspepsia) is mild and only occurs occasionally. However, severe indigestion can cause complications, some of which are outlined below.
Indigestion is often caused by acid reflux, which occurs when stomach acid leaks back up into your gullet (oesophagus) and irritates its lining. If this irritation builds up over time, it can cause your oesophagus to become scarred. The scarring can eventually lead to your oesophagus becoming narrow and constricted (known as oesophageal stricture).
If you have oesophageal stricture, you may have symptoms such as:
- difficulty swallowing (dysphagia)
- food that becomes lodged in your throat
- chest pain
Oesophageal stricture is often treated using surgery to widen your oesophagus.
Like oesophageal stricture, pyloric stenosis is caused by long-term irritation of the lining of your digestive system from stomach acid.
Pyloric stenosis occurs when the passage between your stomach and your small intestine (known as the pylorus) becomes scarred and narrowed. This causes vomiting and prevents any food you eat from being properly digested.
In most cases, pyloric stenosis is treated using surgery to return the pylorus to its proper width.
Repeated episodes of gastro-oesophageal reflux disease (GORD) can lead to changes in the cells lining your lower oesophagus. This is a condition known as Barrett’s oesophagus.
It is estimated that 1 in 10 people with GORD will develop Barrett’s oesophagus. Most cases of Barrett’s oesophagus first develop in people aged 50-70 years old. The average age at diagnosis is 62.
Barrett’s oesophagus does not usually cause noticeable symptoms other than those associated with GORD.
The concern is that Barrett’s oesophagus is a pre-cancerous condition. This means that while changes in the cells are not cancerous, there is a small risk they could develop into "full blown" cancer in the future. This would then trigger the onset of oesophageal cancer.
29 May 2023
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