Indigestion – Illnesses & conditions

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:

• treating gastro-oesophageal reflux disease (GORD)
• treating a stomach ulcer

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.

Healthy weight

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.

Stop smoking

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

At bedtime

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
• alginates

These are described in more detail below.

Antacids

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.

Alginates

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)
• h3-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:

• headaches
• diarrhoea
• constipation
• feeling sick (nausea)
• vomiting
• flatulence
• stomach pain
• dizziness
• skin rashes

h3-receptor antagonists

h3-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 h3-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 h3-receptor antagonists, although ranitidine is available from pharmacies under the Pharmacy First Scotland service. h3-receptor antagonists are usually taken in tablet form.

As with PPIs, you will need to stop taking h3-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.

Acid Reflux Disease Symptoms, Causes, Tests, and Treatments

Written by Annie Stuart

• Acid Reflux
• What Causes Acid Reflux Disease?
• What Are the Symptoms of Acid Reflux Disease?
• How Is Acid Reflux Disease Diagnosed?
• Can Acid Reflux Disease Be Treated With Diet and Lifestyle Changes?
• Can Acid Reflux Disease Be Treated With Medications?
• Is Acid Reflux Disease Ever Treated With Surgery?
• More

At the entrance to your stomach is a valve, a ring of muscle called the lower esophageal sphincter (LES). Normally, the LES closes as soon as food passes through it. But if it doesn’t close all the way or it opens too often, acid made by your stomach can move up into your esophagus. This can cause symptoms such as a burning chest discomfort called heartburn. If acid reflux symptoms happen more than twice a week, you may have acid reflux disease, also known as gastroesophageal reflux disease (GERD).

One common cause of acid reflux disease is a stomach abnormality called a hiatal hernia. This occurs when the upper part of the stomach and LES move above the diaphragm, a muscle that separates your stomach from your chest. Normally, the diaphragm helps keep acid in our stomach. But if you have a hiatal hernia, acid can move up into your esophagus and cause symptoms of acid reflux disease.

These are other common risk factors for acid reflux disease:

• Eating large meals or lying down right after a meal
• Being overweight or obese
• Eating a heavy meal and lying on your back or bending over at the waist
• Snacking close to bedtime
• Eating certain foods, such as citrus, tomato, chocolate, mint, garlic, onions, or spicy or fatty foods
• Drinking certain beverages, such as alcohol, carbonated drinks, coffee, or tea
• Smoking
• Being pregnant
• Taking aspirin, ibuprofen, certain muscle relaxers, or blood pressure medications

Acid reflux disease is also known as gastroesophageal reflux disease (GERD).

Common symptoms of acid reflux are:

• Heartburn: a burning pain or discomfort that may move from your stomach to your abdomen or chest, or even up into your throat
• Regurgitation: a sour or bitter-tasting acid backing up into your throat or mouth

Other symptoms of acid reflux disease include:

• Bloating
• Bloody or black stools or bloody vomiting
• Burping
• Dysphagia – the sensation of food being stuck in your throat
• Hiccups that don’t let up
• Nausea
• Weight loss for no known reason
• Wheezing, dry cough, hoarseness, or chronic sore throat
• Bad breath and/or a bad taste in the mouth
• Chest pain
• Asthma

It’s time to see your doctor if you have acid reflux symptoms two or more times a week or if medications don’t bring lasting relief. Symptoms such as heartburn are the key to the diagnosis of acid reflux disease, especially if lifestyle changes, antacids, or acid-blocking medications help reduce these symptoms.

If these steps don’t help or if you have frequent or severe symptoms, your doctor may order tests to confirm a diagnosis and check for other problems. You may need one or more tests such as these:

Diagnosing Acid Reflux With a Barium Swallow Radiograph

Your doctor may decide to use a special X-ray procedure – the barium swallow radiograph – to rule out any structural problems in your esophagus. In this painless acid reflux test, you will be asked to swallow a solution of barium. The barium enables doctors to take X-rays of your esophagus. Barium swallow isn’t a surefire method of diagnosing GERD. Only one out of every three people with GERD has esophageal changes that are visible on X-rays.

Diagnosing Acid Reflux With Endoscopy or EGD

During an endoscopy, the doctor inserts a small tube with a camera on the end through the mouth into the esophagus. This enables the doctor to see the lining of the esophagus and stomach. Before inserting the tube, your gastroenterologist may give you a mild sedative to help you relax. The doctor may also spray your throat with an analgesic spray to make the procedure more comfortable for you. This acid reflux test typically lasts about 20 minutes. It is not painful and will not interfere with your ability to breathe. While this test may detect some complications of GERD, including esophagitis and Barrett’s esophagus, only about half the people with acid reflux disease have visible changes to the lining of their esophagus.

Diagnosing Acid Reflux With a Biopsy

Depending on what the EGD shows, your doctor may decide to perform a biopsy during the procedure. If this is the case, your gastroenterologist will pass a tiny surgical instrument through the scope to remove a small piece of the lining in the esophagus. The tissue sample will then be sent to a pathology lab for analysis. There it will be assessed to see if there is a disease such as esophageal cancer.

Diagnosing Acid Reflux With Esophageal Manometry

Your doctor may perform an esophageal manometry to help diagnose acid reflux. This is a test to see how well your esophagus is working. It also checks to see if the esophageal sphincter – a valve between the stomach and esophagus – is working as well as it should.

After applying a numbing agent to the inside of your nose, the doctor will ask you to remain seated. Then a narrow, flexible tube will be passed through your nose, through your esophagus, and into your stomach.

When the tube is in the correct position, the doctor will have you lie on your left side. When you do, sensors on the tube will measure the pressure being exerted at various places inside your esophagus and stomach. To further see how well your esophagus is working, you may be asked to take a few sips of water. The sensors on the tube will record the muscle contractions in your esophagus as the water passes down into your stomach.

The test typically takes 20 to 30 minutes.

Diagnosing Acid Reflux With Esophageal Impedance Monitoring

To obtain an even more detailed picture of how well your esophagus is working, the gastroenterologist may recommend esophageal impedance monitoring. If so, this can be done along with manometry. This test uses a manometry tube with electrodes placed at various points along its length. It measures the rate at which liquids and gases pass through your esophagus. When these results are compared with your manometry findings, your doctor will be able to assess how effectively your esophageal contractions are moving substances through your esophagus into your stomach.

Diagnosing Acid Reflux With pH Monitoring

This test uses a pH monitor to record the acidity in your esophagus over a 24-hour period. In one version of this test, a small tube with a pH sensor on the end is passed through your nose into your lower esophagus. The tube is left in place for 24 hours, with the portion exiting your nose affixed to the side of your face. It will be connected to a small recording device that you can wear or carry.

During the course of this acid reflux test, you will record in a diary when you are eating or drinking. You will also push a specific button on the recording device to indicate when you are having acid reflux symptoms. This detailed information will allow the doctor to analyze and interpret your test results.

A newer, wireless version of this test is now being used. In this version, a small pH sensor is affixed to your lower esophagus using suction. The small capsule is able to communicate wirelessly with a recording device outside your body for 48 hours. The capsule ultimately falls off and passes through the remainder of the digestive tract. Many patients have found the wireless pH monitoring exam to be far more pleasant than the traditional version. Both techniques yield similar information.

One of the most effective ways to treat acid reflux disease is to avoid the foods and beverages that trigger symptoms. Here are other steps you can take:

• Eat smaller meals more frequently throughout the day, and modify the types of foods you are eating..
• Quit smoking.
• Put blocks under the head of your bed to raise it at least 4 inches to 6 inches.
• Eat at least 2 to 3 hours before lying down.
• Try sleeping in a chair for daytime naps.
• Don’t wear tight clothes or tight belts.
• If you’re overweight or obese, take steps to lose weight with exercise and diet changes.
• Also, ask your doctor whether any medication could be triggering your heartburn or other symptoms of acid reflux disease.

In many cases, lifestyle changes combined with over-the-counter medications are all you need to control the symptoms of acid reflux disease.

Antacids, such as Alka-Seltzer, Maalox, Mylanta, Rolaids, or Riopan, can neutralize the acid from your stomach. But they may cause diarrhea or constipation, especially if you overuse them. It’s best to use antacids that contain both magnesium hydroxide and aluminum hydroxide. When combined, they may help counteract these gastrointestinal side effects.

If antacids don’t help, your doctor may try other medications. Some require a prescription. Your doctor may suggest more than one type or suggest you try a combination of medications such as these:

• Foaming agents (Gaviscon) coat your stomach to prevent reflux.
• h3 blockers (Pepcid, Tagamet) decrease acid production.
• Proton pump inhibitors (Aciphex, Nexium, Prilosec, Prevacid, Protonix) also reduce the amount of acid your stomach makes.
• Prokinetics (Reglan, Urecholine) can help strengthen the LES, empty your stomach faster, and reduce acid reflux.

Don’t combine more than one type of antacid or other medications without your doctor’s guidance.

If medications don’t completely resolve your symptoms of acid reflux disease and the symptoms are severely interfering with your life, your doctor could recommend surgery. There are two types of surgical treatment used to relieve symptoms of GERD if daily use of medication isn’t effective.

The most recently approved procedure involves surgically placing a ring known as a LINX device around the outside of the lower end of the esophagus, the tube that connects the mouth to the stomach. The ring consists of magnetic titanium beads held together by titanium wires. The device helps ease reflux by preventing stomach contents from backing up into the esophagus. In one study, patients were able to stop taking medicine or cut down the amount they took. You shouldn’t get the LINX device if you’re allergic to certain metals, and once you have a LINX device, you shouldn’t get any type of MRI test.

Another surgical procedure called a fundoplication can help prevent further acid reflux. It creates an artificial valve using the top of your stomach. The procedure involves wrapping the upper part of the stomach around the LES to strengthen it, prevent acid reflux, and repair a hiatal hernia. Surgeons perform this procedure through either an open cut in the belly or chest or with a lighted tube inserted through a tiny cut in the belly.

These procedures are done only as a last resort for treating acid reflux disease after medical treatment hasn’t helped.

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symptoms and diagnosis, prices for the treatment of heartburn in Moscow at the Hadassah clinic

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Heartburn is an unpleasant sensation, up to a burning pain in the upper abdomen. Many people experience discomfort regularly or occasionally, especially after overeating or drinking alcohol. If it happens from time to time, it does no harm. With frequent episodes, we are talking about the development of reflux disease. Heartburn occurs

when the contents of the stomach back up into the esophagus – this backflow is also known as reflux. Thus, heartburn is not an independent disease, but is a consequence.

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Symptoms of heartburn

Heartburn is not a disease, but a manifestation of reflux. Discomfort in the chest and neck is aggravated by leaning forward, physical activity and eating. Patients complain of the presence of sour belching and an unpleasant aftertaste in the oral cavity. Additional symptoms depend on the severity of the reflux disease. Thus, the patient may experience a violation of food intake and a manifestation of indigestion. Sometimes there is no discomfort at all.

Additional symptoms of heartburn that indicate the presence of reflux disease:

• increased salivation;
• nausea and bitterness in the mouth;
• discomfort when swallowing food;
• occurrence of bad breath;
• lump in throat and characteristic burning;
• chronic cough and hoarseness;
• sleep problems;
• poor appetite.

In the chronic form of the disease, there are violations of the respiratory system. Inflammation of the lungs may develop, which occurs due to the reflux of gastric juice into the respiratory tract. Bronchial asthma can be complicated by frequent attacks.

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Causes of heartburn

Heartburn can have several causes. In most cases, they remain unclear. Most often, heartburn develops against the background of an unhealthy lifestyle and diet, which overload the stomach. For example, stress can literally hit the stomach and cause heartburn because it stimulates stomach acid production, delays emptying, and promotes reflux.

Other factors that can cause heartburn include:

• excessive body weight;
• alcohol abuse;
• smoking;
• inclusion in the diet of fatty and fried foods;
• eating hot spices such as garlic, mustard or horseradish;
• meal before going to bed.

Medicines are also among the causes of heartburn. They can both cause heartburn and increase existing discomfort. For some medications, reflux is a possible side effect. Painkillers from the group of so-called non-steroidal anti-inflammatory drugs cause heartburn especially often. Therefore, those who are prone to heartburn should prophylactically take a gastric protector during drug therapy.

In addition, there are some diseases that sometimes cause heartburn, for example:

• functional dyspepsia;
• diaphragmatic hernia;
• gastritis and gastric ulcer;
• stenosis and achalasia of the esophagus.

Delayed gastric emptying can also lead to heartburn and reflux. Usually, solid food stays in the stomach for 1 to 5 hours. Liquids are absorbed much faster – with an empty stomach, they enter the small intestine in an average of 10-20 minutes.

Methods for diagnosing heartburn

If you experience a symptom such as heartburn, you should make an appointment with a gastroenterologist. The doctor will take a history of the disease and conduct an initial examination. Comprehensive diagnostics for heartburn allows you to obtain accurate information about the state of the gastrointestinal tract (gastrointestinal tract) of the patient. To determine the cause of heartburn, the specialist will prescribe the following tests:

Esophagogastroduodenoscopy

examination of the mucous membrane of the esophagus, duodenum and esophagus

X-ray of the esophagus

Diaphragmatic herniation and complications of reflux disease

Electromyography

Examination of the muscles of the esophagus

Treatments for heartburn

Medication is given to reduce stomach acid, relieve symptoms, and address the cause of heartburn. In addition to drugs, the gastroenterologist prescribes a diet that allows you to normalize the activity of the intestines and stomach.

Medicines used to treat heartburn:

• Antacids. Neutralize acid, relieve discomfort and pain from heartburn.
• Proton pump inhibitors and H2-histamine receptor blockers. They inhibit the production of hydrochloric acid and improve the condition.

Medication for heartburn can last from 2-3 weeks to 6 months. Each stage of therapy is additionally controlled by a doctor to adjust dosages and eliminate the likelihood of complications.

Surgical intervention for heartburn is necessary only when another pathology was identified during the diagnosis, leading to dysfunction of the digestive tract.

Heartburn prevention and treatment programs at the Hadassah Clinic

As a preventive measure for heartburn, standard medical recommendations are used to prevent the reflux of stomach contents into the esophagus:

• lose extra pounds;
• avoid spicy, salty and fatty foods;
• give up alcohol and cigarettes;
• do not eat 2-3 hours before bedtime.

The Hadassah clinic in Moscow performs two types of operations to eliminate the cause of heartburn:

• Radiofrequency ablation of the esophagus – normalization of the functions of the esophageal sphincter.
• Endoscopic application – prevents the backflow of acid into the esophagus.

Text reviewed by medical expert

Kanevskaya
Svetlana Sergeevna

Medical director, therapist, doctor of medical sciences, professor

Doctor of medical sciences

Work experience: 22 years

Published: 06/24/2022 90 003

Updated: 06/24/2022

The information provided on the site is for reference only and cannot serve as a basis for making a diagnosis or prescribing treatment. Internal consultation of the expert is necessary.

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