Heartburn and indigestion — your questions answered

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It’s the season for eating, and that can come with feelings of a burning in the chest, gas and other signs of heartburn and indigestion. A GP gives her tips

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Quick facts

  • Indigestion and heartburn are widespread — 40% of adults experience it
  • Spicy, fatty foods as well as coffee and alcohol are common triggers
  • Being overweight and obese, as well as smoking and stress, are also key causes

Most people suffer from indigestion occasionally and some are more prone to it than others.

Indulging in rich food and alcohol can overload our digestive systems and leave us with uncomfortable feelings – like heartburn and gas – after eating.

Here we answer your questions, with advice from Dr Rhianna McClymont, Lead GP, Livi.

What’s the difference between heartburn, acid reflux and indigestion?

Indigestion can be felt as discomfort or pain in the upper abdomen, also known as dyspepsia. It’s incredibly common with around 40% of adults experiencing it each year.

One of the main symptoms of indigestion is heartburn and acid reflux (these are the same thing, by the way). Heartburn is felt as a burning sensation behind your breastbone or in your throat. It happens when acid from your stomach comes up your oesophagus and into your throat, which is called acid reflux. Most people only have occasional episodes, but when this keeps happening, it’s called gastro-oesophageal reflux disease (GORD).

Dyspepsia and heartburn may occur together or on their own and symptoms usually appear soon after eating or drinking.

What causes indigestion?

As well as heartburn, belching or flatulence, bringing food back up from your stomach into your throat, nausea, and feeling uncomfortably full are also symptoms of indigestion. They’re caused by stomach acid irritating the protective lining of the digestive system.

Indigestion can also be due to the lining in your digestive system being overly sensitive to stomach acid, or it may be stretched as a result of eating too much.

‘Heartburn is most commonly caused by a laxity in the lower oesophageal sphincter,’ says Dr Rhianna McClymont. This sphincter forms a tight ring between the top of the stomach and bottom of the oesophagus (the food pipe). It opens to let food pass from the oesophagus and into the stomach, and then closes again to prevent stomach acid and food travelling the wrong way back into the oesophagus. ‘With acid reflux, this sphincter is more relaxed than it should be, allowing acid to pass out of the stomach and cause painful symptoms,’ Dr McClymont explains.

What triggers heartburn and indigestion?

Coffee and alcohol, as well as spicy and fatty foods — including chocolate and tomatoes, according to the NHS — can be common triggers for indigestion.

If you’re overweight or obese, you may be more likely to suffer with indigestion.

Some medicines, like anti-inflammatory painkillers, can cause it too. ‘Medications like ibuprofen are a particularly common trigger for heartburn, so make sure you’re not taking these regularly, unless you have been directed to by your own GP,’ says Dr McClymont.

Stress can also make indigestion worse — as can smoking.

Indigestion is particularly common in pregnant women, usually from 27 weeks onwards, with up to 45% of pregnant women suffering from it at some point. This can be caused by hormonal changes and the growing baby pressing against the stomach.

How can I prevent indigestion?

There are many things you can do to prevent an episode of indigestion. Start by avoiding foods that you know trigger episodes. Cutting back on alcohol and stopping smoking can also help.

If you’re overweight or obese, research suggests that losing weight can be helpful in alleviating symptoms.

Try to avoid overeating by opting for smaller, more frequent meals. If you can, make your evening meal 3-4 hours before bedtime, as lying down can cause symptoms.

In fact, if you find that you suffer from indigestion mostly when you’re lying down in bed, try raising the top of your bed by 10-20cm with some pillows. Ideally, your chest and head should be above the level of your waist so your stomach acid doesn’t travel up towards your throat. Avoid tight clothes that put pressure on your stomach area too.

If stress triggers your indigestion, a course of Cognitive Behavioural Therapy (CBT) can help you better deal with pressures and stressors in your life.

What’s the best over-the-counter medicine?

‘Different preparations work better for different individuals,’ says Dr McClymont. Pharmacies will usually stock a range of over-the-counter medicines such as antacids and proton pump inhibitor (PPI) drugs as well as H2 blockers, she explains.

‘For mild, occasional, heartburn symptoms, an antacid is generally all that’s needed,’ says Dr McClymont. ‘There are numerous brands available and a pharmacist would be able to talk you through the different options.’

Antacids work by neutralising the acid made by your stomach. Widely available from pharmacies, they’re the medication that most people turn to when they first start suffering from heartburn or indigestion — and most people don’t develop any side-effects.

H2 blockers reduce the amount of acid your stomach makes and are usually taken as tablets, soluble tablets or a drink, with or without food.

PPIs work on the cells that line the stomach to reduce the acid your stomach makes. However, if you need to use a PPI for more than 4 weeks you should talk to your doctor.

I always seem to have indigestion after eating, what should I do?

‘If you have constant indigestion that hasn’t improved with lifestyle changes, talk to a doctor,’ says Dr McClymont. ‘They can discuss your individual symptoms, lifestyle and medication history, and make a plan on whether you need further treatment or investigations.’ A Livi doctor can help take you through this.

What are the signs I need to see a doctor?

‘If you’ve tried to treat indigestion yourself with lifestyle adaptations or over-the-counter medications and are still experiencing symptoms, then it is best to see your doctor,’ says Dr McClymont.

Talk to a doctor or Livi GP if your indigestion persists, or you experience any of the following alongside it:

  • Severe pain
  • Sudden weight loss without meaning to
  • You’re 55 or older
  • Have difficulty swallowing
  • Keep being sick
  • Have iron deficiency anaemia
  • Feel like you have a lump in your stomach
  • Have blood vomit or poo

Could indigestion be a sign of something more serious?

‘Indigestion is common and will usually resolve quickly with lifestyle changes or over-the-counter medications,’ says Dr McClymont.

‘Occasionally, it can be something more serious. If you’re worried, your indigestion has become persistent or it’s occurring with other symptoms then you should speak to a GP.’

Rarely, it’s a sign of something more serious for example, hiatus hernia, an infection, stomach ulcer or in rare cases, cancer. There’s probably no reason to worry, but it’s always worth discussing with a doctor if your indigestion is persistent and unresponsive to lifestyle changes.

How Livi can help

If lifestyle changes and medication don’t help, your doctor may refer you for an endoscopy, for further investigation. An endoscope is a long, thin, flexible tube that has a light and camera at one end so images of the inside of your body can be seen on a screen. It’s not usually painful but may be a little uncomfortable and usually takes 15-45 minutes. This procedure can help a specialist determine any deeper causes of your indigestion and identify a course of suitable treatment.

This article has been medically approved by Dr Rhianna McClymont, Livi Lead GP

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