Indigestion

Indigestion refers to symptoms of discomfort in the upper abdomen during and after a meal, including pain or burning and uncomfortable fullness. It is not a distinct condition but may be a sign of a digestive tract disease. Treatment for indigestion not caused by an underlying disease may involve lifestyle changes and medication.

General information

Indigestion - also known as dyspepsia - is a collective term for a set of digestive symptoms that are experienced during and after eating a meal or drinking. It is a common condition which may affect one in four people.

There are three different types of indigestion:

• Occasional —occurring infrequently
• Chronic—occurring daily for a few weeks or months
• Functional—chronic symptoms without a definite cause.

Causes

There are many causes of indigestion, most of which are related to lifestyle. Common causes include:

• Eating too quickly or too much during a meal
• Spicy, fatty, or greasy foods
• Acidic foods, such as tomatoes, tomato products, and oranges
• Too much alcohol, coffee, and caffeinated or carbonated drinks
• Stress and anxiety
• Smoking
• Some medications, including certain antibiotics, non-steroidal anti-inflammatory drugs (NSAIDs), and iron supplements.

Indigestion can be related to health problems and digestive tract conditions, including:

• Gastritis
• Inflammation of the pancreas (pancreatitis)
• Gallstones
• Gastroparesis (delayed emptying of food from the stomach)
• Helicobacter pylori (H. pylori) infection (the bacterium associated with peptic ulcers)
• Peptic ulcer disease
• Lactose intolerance
• Stomach cancer
• Coeliac disease (gluten intolerance)
• Bowel obstruction.

Indigestion for which no obvious cause can be identified is known as functional dyspepsia. It is thought to be associated with inflammation of the upper digestive (gastrointestinal) tract and bowel movement dysfunction, which may be triggered by an infection or allergic response, or a change in the composition of the bowel microbiome (microbial flora).

Signs and symptoms

The following are signs and symptoms of indigestion:

• Feeling full without having eaten much of a meal and possibly being unable to finish a meal
• A feeling of uncomfortable fullness after a meal, which may be long-lasting
• Mild to severe pain in the upper abdomen (the area between the bottom of the breastbone and the navel)
• Burning sensation in the upper abdomen
• Bloating in the upper abdomen
• Burping or belching, including bringing up food or bitter-tasting fluid
• Feeling sick and wanting to vomit (i.e. nausea).

Indigestion can be confused with heartburn (acid reflux or GERD), which is another type of digestive condition, and some people with indigestion also experience heartburn. In contrast to indigestion, which is felt in the upper abdomen, heartburn is a pain or burning sensation that is felt in the centre of the chest and which may spread into the neck or back during or after eating.

You should consult your doctor if indigestion persists for more than two weeks. If indigestion is accompanied by any of the following symptoms, you may have a more serious condition and should contact your doctor right away:

• Shortness of breath, sweating, or chest pain that spreads to the jaw, neck, or arm
• Chest pain triggered by physical exertion or stress
• Severe and constant abdominal pain
• Repeated vomiting or vomiting with blood
• Black, tar-like stools
• Difficult or painful swallowing that gets progressively worse
• Loss of appetite or unintended weight loss
• Fatigue or tiredness, which suggests anaemia.

Diagnosis

A diagnosis of indigestion can usually be made based on a review of a person’s symptoms and medical history, and a physical examination.

An upper gastrointestinal endoscopy and other tests may be recommended for people whose indigestion began suddenly and who have severe symptoms, people with indigestion who are older than 55 years, or people with indigestion of any age who also have:

• A family history of cancer
• Difficulty swallowing
• Evidence of bleeding in the digestive tract
• Frequent vomiting
• Weight loss.

An upper gastrointestinal endoscopy checks for abnormalities in the upper digestive tract. A tissue sample (biopsy) may be taken for analysis to look for digestive tract diseases and conditions.

Other tests may include:

• Laboratory tests, to check for metabolism disorders
• Blood, breath, and stool tests, to check for presence of H. pylori.
• Imaging tests (X-ray or CT scan), to check for intestinal obstruction and digestive tract abnormalities.

Treatment

Treatment for indigestion depends on the cause and may include lifestyle changes, over-the-counter and prescription medications, and psychological therapies.

Lifestyle remedies

Lifestyle changes that may help to relive the symptoms of indigestion include:

• Avoiding foods that trigger indigestion
• Eating smaller more-frequent meals instead of three large meals a day
• Chewing food slowly and thoroughly
• Reducing or eliminating the use of alcohol, caffeine, and carbonated beverages
• Quit smoking
• Avoiding, reducing, or finding alternatives for medications (e.g. NSAIDs) that trigger indigestion
• Losing weight if overweight/maintaining a healthy weight
• Exercising regularly
• Reducing stress and anxiety.

Medications

Medications may help to relieve symptoms of persistent indigestion. Antacids you can buy at a pharmacy and some other retail outlets - e.g. calcium carbonate and sodium bicarbonate, which neutralise stomach acid, and simethicone, which reduces bloating - are generally the first options to consider.

Other pharmacy-only and prescription medications could also be beneficial, including:

• Proton pump inhibitors (PPIs), such as omeprazole and pantoprazole, which act by reducing stomach acid
• H2-blockers, e.g., cimetidine, famotidine, which can also reduce stomach acid
• Prokinetics, such as metoclopramide, which help empty the stomach more quickly
• Antibiotics, such as clarithromycin and metronidazole, if H. pylori is causing your indigestion
• Antidepressants or anti-anxiety medications, e.g., tricyclic antidepressants, which may ease the discomfort from indigestion by decreasing your sensation of pain.

Psychological therapies

Psychotherapy (taking therapy) may be recommended to help treat anxiety and depression that may be causing your indigestion. Meditation, mindfulness and relaxation exercises, and counselling may also be beneficial in controlling stress and anxiety.

References

Mayo Clinic (2016). Indigestion (Web Page). Rochester, NY: Mayo Foundation for Medical Education and Research. https://www.mayoclinic.org/diseases-conditions/indigestion/symptoms-causes/syc-20352211 [Accessed: 10/05/18]
National Institute of Diabetes and Digestive and Kidney Diseases (2016). Indigestion (Dyspepsia) (Web Page). Bethesda, MD: National Institutes of Health (NIH). https://www.niddk.nih.gov/health-information/digestive-diseases/indigestion-dyspepsia [Accessed: 10/05/18]
NHS Choices (2016). Indigestion (Web Page). Redditch: National Health Service (NHS)
England. https://www.nhs.uk/conditions/indigestion/ [Accessed: 10/05/17]
O’Toole, M.T. (Ed.) (2013). Dyspepsia. Mosby’s Dictionary of Medicine, Nursing & Health Professions (9th ed.). St Louis, MI: Elsevier Mosby.
Talley, N.J., Goodsall, T., Potter, M. (2017). Functional dyspepsia. Aust Prescr. 2017; 40(6): 209-213.

Updated: May 2018

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