Life Pharmacy
Advice for living well

Indigestion and Heartburn

Indigestion (sometimes called dyspepsia) is a general term to describe an uncomfortable feeling in the stomach or upper abdominal area. Sometimes the discomfort includes a burning pain (heartburn). People with indigestion and heartburn may complain of one or more of the following symptoms:

Symptoms

  • Discomfort or pain between your ribs and belly button. Eating may worsen or relieve symptoms.
  • A burning feeling behind your breast bone and moving up towards the throat. These feelings usually occur about 30 minutes after eating or lying down.
  • Too much gas, feeling bloated (may be relieved by burping).
  • Feeling sick (nausea).
  • Feeling full or needing less food than usual to make you feel full.
  • A ‘lump’ in your throat, or having trouble swallowing.

Causes

Indigestion is very common. Mostly, indigestion is due to some temporary abnormality - a response to certain food or to certain medicines (especially aspirin or other anti-inflammatories), or a passing infection. Often the cause will not be found but you will have recovered from the episode in a few days. However, indigestion can be a symptom of other problems such as oesophageal reflux, peptic ulcer disease, irritable bowel syndrome, stomach cancers, or heart problems. See the When to contact your doctor section.

Heartburn is caused by the contents of the stomach, especially acid, going back into the oesophagus (the tube joining the throat to the stomach - see diagram next page) and causing irritation. A special valve at the lower end of the oesophagus normally prevents this reflux but can be weakened by a number of factors, leading to heartburn (also known as gastro oesophageal reflux disease or GORD).

Indigestion and heartburn can be caused, or made worse, by:

  • smoking
  • coffee and strong tea
  • alcohol
  • spicy and fatty foods
  • foods such as cucumber, onion, chocolate
  • pregnancy
  • weight increase stress
  • rushed, or missed, meals, and large meals
  • some medicines, such as aspirin or other anti-inflammatories for pain or arthritis.

Treatment

Lifestyle changes

Avoid smoking, and foods that cause your indigestion. Reduce your alcohol intake. Lose weight if applicable and eat small, regular, meals.

Antacids and alginates

Antacids help to neutralise acid in the stomach. They should be taken half an hour after meals to be most effective. They generally provide quick and effective relief from symptoms. Antacids are available as tablets and liquids. Tablets are easier to carry around, and should be sucked or chewed before swallowing. Liquids work faster. Antacids should be taken when you have indigestion or when you think you might get it, such as in between meals and at bedtime.

Antacids can interact with some medicines, affecting the absorption of those medicines. As a rule, take antacids and other medicines 2 - 3 hours apart. Discuss this with your LIFE Pharmacist.

Alginates, often combined with antacids, are used if heartburn (reflux) is your major symptom. Alginates form a gel or foam on top of the contents of your stomach, acting as a barrier between the acid and the oesophagus. This prevents further irritation of the oesophagus.

Motility-modifying agents

Medicines like domperidone ease indigestion by emptying the stomach of food more quickly, and making the oesophageal valve stronger.

Acid-lowering medicines

H2 antagonists - such as famotidine and ranitidine. These decrease the amount of acid made in the stomach. This reduces indigestion and reflux symptoms. H2 antagonists can be used when antacids and alginates have not worked. H2 antagonists may interact with some medicines. Check with your life Pharmacist if you take any medicines either prescribed by your doctor or bought from a pharmacy or other source.

Consult with your doctor before taking H2 antagonists if you are pregnant or breastĀ­feeding.

Proton pump inhibitors - such as omeprazole and pantoprazole. These agents are the medicines of choice in heartburn but also may be effective in some people with indigestion.

Indigestion and heartburn medicines that you buy, rather than have prescribed by your doctor, should not be taken for periods longer than two weeks without advice from your LIFE Pharmacist or doctor.

Self care

There are changes you can make in your lifestyle to avoid indigestion and heartburn:

Eat foods high in fibre, for example cereals, fruit and vegetables. Avoid eating rich, fatty, or very spicy, foods.

Eat smaller, more frequent, meals.

Eat slowly. Do not rush meals.

  • Drink six to eight glasses of water every day.
  • Drink less alcohol, strong tea, coffee, guarana drinks , chilled or fizzy drinks - avoid these altogether.
  • Stop smoking - your LIFE Pharmacist can help you quit.
  • If you are overweight, lose weight.
  • Exercise for at least 20 minutes, three times a week.
  • Try not to bend or stoop during exercises.
  • Bend your knees when picking up things. Use a ‘kneeler’ for gardening.
  • Learn to relax and reduce stress.
  • Finish eating or drinking at least two hours before going to bed.
  • Wear loose-fitting clothes, especially around your waist.
  • If you have heartburn at night, try raising the head of your bed by placing 1 0-15cm blocks under the bed, or use extra pillows.
  • Take all medicines while sitting up (if unable to stand up) and with a glass of water, to ensure that the tablet/capsule does not stick in the oesophagus and cause irritation.
  • Take medicines with food, if the label says so.

Indigestion may be a sign of a more serious problem (as discussed under the Causes section). Watch for these warning signs and contact your doctor if:

  • Your indigestion is not helped by the lifestyle changes advised in the Self care section.
  • You are 50 years of age or older and have previously had good digestion.
  • You have a family history of stomach cancer in family members aged less than 50 years.
  • Your bowel motions are dark or black and look like tar.
  • Your vomit appears to contain blood or looks like ground coffee.
  • You have recently lost weight and/or feel generally unwell.
  • You have pain, or difficulty, swallowing food.
  • Your chest pain or burning is not helped with indigestion remedies, or it returns immediately after stopping treatment.
  • You are taking aspirin or another anti-inflammatory medicine regularly.
  • A child under 12 years has indigestion.

Indigestion and heartburn usually settle down within 2 - 5 days of treatments. See your doctor if you have tried the non-prescription treatments suggested on this card (e.g. antacids and H2 antagonists) and your symptoms have not settled, or continue to get worse. Your doctor may prescribe other medicines (such as proton pump inhibitors) to help your symptoms, or order specific tests to rule-out other conditions.

 

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