Over-The-Counter (OTC) Heartburn Treatment | FDA

What is heartburn?

Heartburn occurs when stomach contents flow back up into the esophagus—the muscular tube that carries food and liquids from the mouth to the stomach. Also called acid indigestion, heartburn is an uncomfortable, burning feeling in the mid-chest, behind the breastbone, or in the upper part of the abdomen—the area between the chest and the hips. This feeling occurs because the stomach’s digestive juices contain acid. Sometimes people with this problem can taste food or acidic fluid in the back of the mouth.

What are my OTC treatment options?

There are three classes of OTC medications for the treatment of heartburn.

Antacids

Antacids relieve heartburn (indigestion). They work by changing the stomach acid that causes heartburn. Common OTC antacids include:

Histamine-2 (h3) blockers

h3 blockers relieve and prevent heartburn and work by reducing the amount of acid produced by the stomach. Typically, they start to work within one to three hours and provide acid-suppression for several hours. Because acid reducers may interact with certain other medicines, ask your doctor or pharmacist before use if you are taking a prescription drug.  Common OTC h3-blockers include:  

• Tagamet HB (cimetidine)
• Pepcid Complete or Pepcid AC (famotidine)
• Axid AR (nizatidine)

Proton pump inhibitors (PPIs)

OTC PPIs treat frequent heartburn (occurs 2 or more days a week) and are not intended for immediate relief of heartburn, as they may take one to four days for full effect. In contrast, prescription PPIs are used to treat conditions like gastroesophageal reflux disease (GERD), stomach and small intestine ulcers, and inflammation of the esophagus. PPIs work by reducing the amount of acid produced by the stomach. Because acid reducers may interact with certain other medicines, ask your doctor or pharmacist before use if you are taking a prescription drug.  OTC PPIs are only intended for a 14-day course of treatment and can be used up to three times per year.

• Prevacid 24HR (lansoprazole)
• Nexium 24HR (esomeprazole)
• Prilosec OTC (omeprazole magnesium)
• Zegerid OTC (omeprazole and sodium bicarbonate)

How do I use these drugs safely and effectively?

1. Read the label.
2. Do not take more than directed or use for longer than directed on the label.
3. If your heartburn symptoms persist even after taking these drugs, then talk to a health care professional.

More Safety Information

Antacids

Proton Pump Inhibitors (PPIs)

General

If you experience a serious side effect, you or your doctor may send a report to the Food and Drug Administration’s (FDA) MedWatch Adverse Event Reporting program online or by phone (1-800-332-1088).

More Consumer Information

Antacids

Proton Pump Inhibitors (PPIs)

h3-Blockers

Regulatory Information

• Content current as of:

  03/12/2021

Indigestion medicines | Health Information

Types of indigestion medicine

There are three main types of medicine for indigestion. They are:

• antacids and alginates
• proton pump inhibitors
• h3-blockers

These all act in different ways to either neutralise or block production of stomach acid – which is often associated with indigestion.

Antacids and alginates

You can buy these medicines over the counter to treat your indigestion, without a prescription from a doctor. Antacids usually contain aluminium, magnesium, calcium or sodium compounds, which act to neutralise your stomach acid. They’re often combined with an alginate. These form a protective layer over the surface of your stomach contents to prevent acid rising back up your oesophagus (the tube that goes from your mouth to your stomach). Sometimes another medicine (simeticone), which reduces wind, is added too.

Examples include Gaviscon, Maalox, Remegel, Settlers and Tums. Check the patient information leaflet or ask your pharmacist to find out exactly what active ingredients your medicine contains.

Proton pump inhibitors

You can also take a proton pump inhibitor (PPI) if you keep getting heartburn. You can buy a PPI from your pharmacy if it’s just for short-term or occasional use. If you start to need PPIs more often or you’re known to have peptic ulcers or gastro-oesophageal reflux disease (GORD), your GP may prescribe one. They work by reducing the amount of acid produced by your stomach.

Examples include omeprazole (for example, Losec, Mezzopram) and lansoprazole (for example, Zoton).

h3-blockers

You can buy low-dose h3-blockers for short-term use from your pharmacist without a prescription. Your GP may also prescribe h3-blockers in stronger doses and for longer if you have ongoing problems with indigestion. Like PPIs, these medicines stop your stomach from producing so much acid – although they work in a different way.

An example of an h3 blocker is ranitidine (for example, Gavilast, Zantac).

Dyspepsia: What It Is and What to Do About It

Please note: This information was current at the time of publication. But medical information is always changing, and some information given here may be out of date. For regularly updated information on a variety of health topics, please visit familydoctor.org, the AAFP patient education website.

Information from Your Family Doctor

Am Fam Physician.  2010 Dec 15;82(12):1459-1460.

What is dyspepsia?

It is a pain or an uncomfortable feeling in the upper middle part of your stomach area. The pain might come and go, but it’s there most of the time. You might feel too full after a meal or too full to finish a meal. You can get it at any age.

What are the symptoms of dyspepsia?

If you have these signs, or any kind of stomach pain or discomfort, talk to your doctor.

What causes dyspepsia?

Often, doctors can’t find a cause for the irritation to the stomach lining. Stomach ulcers or acid reflux can cause dyspepsia. If you have reflux, stomach acid backs up into your esophagus (the tube leading from your mouth to your stomach). This causes pain in your chest. Your doctor may do some tests to find out if you have an ulcer or reflux disease. Some medicines, like anti-inflammatory pain relievers, can cause dyspepsia.

Is dyspepsia a serious condition?

Not usually, but sometimes the symptoms can be a sign of more serious disease (for example, a deep stomach ulcer). Rarely, stomach cancer can cause dyspepsia. If you have dyspepsia, talk to your doctor. This is especially important if you are older than 50 years, have recently lost weight without trying to, have trouble swallowing, have severe vomiting, have stools that are black and tarry, or if you can feel a lump in your stomach area.

How is dyspepsia treated?

Most often, medicine can take care of this condition. If you have a stomach ulcer, it can be cured. You may need to take an acid-blocking medicine. If you have an infection called H. pylori in your stomach, you may also need to take antibiotics.

If your doctor thinks that a medicine you’re taking causes your dyspepsia, you might need to try another one.

A medicine that cuts down on the amount of acid in your stomach might help your pain. This medicine can also help if you have acid reflux disease.

Your doctor might want you to have a procedure called an endoscopy if:

During an endoscopy, a small tube with a camera inside it is put into your mouth and down into your stomach. Then your doctor can look inside your stomach to try to find a cause for your pain.

Do the medicines for dyspepsia have side effects?

Usually, they have only minor side effects that go away on their own. Some medicines can make your tongue or stools black. Some may cause headaches, nausea, or diarrhea.

If you have side effects that make it hard for you to take the medicine, talk to your doctor. You may need to try a different medicine, or your doctor may suggest ways to make the side effects less bothersome. Be sure to ask your doctor if there are side effects from using these medicines for a long time.

Remember to take medicines just the way your doctor tells you. If you need to take antibiotics, take all of the pills, as instructed, even after you start feeling better.

Can I do anything else to avoid dyspepsia?

Yes, for example:

• If you smoke, stop smoking.

• If some foods bother your stomach, try not to eat them.

• Try to reduce the stress in your life.

• If you have acid reflux, don’t eat right before bedtime. Raising the head of your bed with blocks under two legs may also help.

• Unless your doctor tells you otherwise, don’t take a lot of anti-inflammatory medicines like ibuprofen (one brand: Motrin), aspirin, naproxen (brand name: Aleve), and ketoprofen (brand name: Orudis). Acetaminophen (brand name: Tylenol) is a better choice for pain, because it won’t hurt your stomach.

Indigestion | Health Navigator NZ

Indigestion is a word used to describe stomach pain or discomfort after eating. It is not a disease on its own, but a group of symptoms (such as stomach pain, bloating, or a sense of fullness) you feel soon after eating.

Indigestion is common, affecting up to 40% (4 in 10) adults in New Zealand every year. It is often confused with heartburn.

Heartburn is a burning feeling rising from the stomach into the chest and up towards the neck. Frequent heartburn is most commonly a symptom of reflux disease (GORD). 

What causes indigestion?

The most common type of indigestion is known as functional dyspepsia. The exact cause of functional dyspepsia is unknown but it is often related to lifestyle. It may be triggered by food, drink or medication. For example:

• eating too much or too quickly
• fatty, greasy or spicy foods
• too much caffeine, alcohol, chocolate or carbonated drinks
• taking over-the-counter medications such as ibuprofen or aspirin
• stress or anxiety.

Functional dyspepsia accounts for 70% of cases of indigestion. Other causes include:

• Stomach ulcers (15 to 20%).
• Acid reflux (5 to 15%).
• Some people get ulcers in their stomach or intestines from bacteria called Helicobacter pylori. Infection from this bacteria can cause indigestion.
• Other causes, such as cancer, heart disease, disease of the digestive tract and medication effects are rare.

What are the symptoms of indigestion?

People with indigestion often experience:

• early fullness during a meal or uncomfortable fullness after eating
• a gnawing or burning stomach pain
• nausea and vomiting
• bloating
• burping.

When to see your doctor about indigestion

Mild indigestion that happens now and again is common and usually nothing to worry about. However, it is important to see your doctor if the discomfort is severe and ongoing, or if you have indigestion in combination with the following symptoms or risk factors:

• unintended weight loss
• difficulty swallowing
• persistent vomiting
• blood in dark coloured stools (poos)
• tightness or discomfort in your chest with exercise
• family history of cancer.

These symptoms could indicate a more serious underlying medical condition and can be easily confused with heart problems, such as angina. Sometimes indigestion can be a symptom of another digestive disease, such as stomach ulcers or acid reflux.  

How is indigestion diagnosed?

To diagnosis indigestion, your doctor will  take a detailed history and conduct a physical examination to try to identify any possible causes for your indigestion. 

Sometimes your doctor might want you to have an endoscopy. This may be because your symptoms suggest a disease of your digestive track, or it may be because you:

• have had no improvement in symptoms after making lifestyle changes and
• still have stomach pain after taking an indigestion medicine for 8 weeks.

Self care for indigestion

In about 8 out of 10 people, indigestion symptoms can settle by making some simple changes such as healthier eating or losing weight. The following tips may help prevent indigestion: 

• stop taking over-the-counter anti-inflammatory medicines
• drink less alcohol
• cut down on coffee and fizzy drinks
• quit smoking
• avoid large meals in the evening
• remove foods from your diet that makes symptoms worse (i.e: fatty or spicy foods)
• reduce your weight if you are overweight
• find ways to reduce the amount of stress you are under or explore healthy ways of coping with it. Talk to your doctor if you feel that stress is getting on top of you.

What are the treatment options for indigestion?

For mild indigestion that happens now and again, antacids may be helpful in relieving the symptoms. These work by neutralising stomach acid.

If your symptoms are causing ongoing pain and discomfort, see your doctor for a proper check. Treatment will depend on what is causing your indigestion:

• If you have discomfort, bloating, feeling full and nausea, you may need to take a medication that helps gut movement (eg, domperidone) 
• If you have a stomach ulcer or acid reflux, you may need to take an acid-blocking medicine such as ranitidine, famotidine or a proton pump inhibitor.
• If a bacterial infection is causing your symptoms, antibiotics will be prescribed.
• If your doctor thinks that a medicine you’re taking may be causing your indigestion, you might need to change medicines.
• If depression or anxiety is thought to be leading to stomach pain, antidepressant or anti-anxiety medication may be prescribed.

Tell your doctor if your symptoms persist after taking the prescribed medication. Your medicine may need to be changed or further tests arranged. 

Learn more

Indigestion NHS Choices, UK
Indigestion Mayo Clinic Online (US), 2013
Dyspepsia  Best Practice Journal (NZ), 2011

References

Managing dyspepsia and heartburn in general practice – an update Best Practice Journal, Feb 2011
Management of dyspepsia and heartburn New Zealand Guidelines Group, Ministry of Health NZ, 2004

Guidelines

Managing dyspepsia and heartburn in general practice – an update Best Practice Journal (NZ), 2011
Management of dyspepsia and heartburn NZ Guidelines Group, 2007
Update on the Evaluation and Management of Functional Dyspepsia  American Family Physician, 2011

Clinical pathways

The Northern Region Dyspepsia Clinical Pathway (2014) recommends:

Dysmotility-type symptoms such as discomfort, bloating, early satiety, nausea rather than pain for these patients,

• prokinetic agents eg, domperidone 10mg tds is recommended first line,
• then h3 antagonists such as ranitidine (better response rate than PPIs in this group).

Ulcer-type symptoms (some may be atypical gastro-oesopheageal reflux disease)

• these respond better to acid-suppression first line (h3 antagonists such as ranitidine or PPI – such as omeprazole).
• Non-response to one group should prompt trial of the other group of medication.

Continuing professional development

Long term risks of PPIs by Dr Tien Huey

(The Goodfellow Unit, 2018)

Regional HealthPathways NZ

Access to the following regional pathways is localised for each region and access is limited to health providers. If you do not know the login details, contact your DHB or PHO for more information: 

Indigestion – NHS Choices

Indigestion (dyspepsia) is a general term for pain or discomfort felt in the stomach and under the ribs. 

Heartburn is when acid moves up from the stomach into the gullet (oesophagus) and causes a burning pain behind your breastbone. 

Indigestion and heartburn can occur together or on their own.

It’s a common problem that affects most people at some point. In most cases it’s mild and only occurs occasionally.

This page covers:

Symptoms of indigestion

What causes indigestion

When to see your GP

Further investigations

Treating indigestion

Complications of indigestion

Symptoms of indigestion

As well as heartburn, other common symptoms of indigestion include:

• feeling uncomfortably full or bloated
• feeling sick
• belching or passing wind (flatulence)
• bringing up food or fluid from your stomach

These symptoms usually occur soon after eating or drinking, although there can sometimes be a delay between eating and getting indigestion.

What causes indigestion?

Indigestion is usually related to eating. When you eat, your stomach produces acid. The acid can sometimes irritate your stomach lining, the top part of the bowel, or the oesophagus.

This irritation can be painful and cause a burning sensation, particularly if the lining of your digestive system is overly sensitive to acid.

Your stomach can also stretch after eating a big meal, causing acid reflux, where the acid moves up into your oesophagus.

Indigestion can also be triggered or made worse by a number of other factors:

Medication

Some medicines, such as nitrates – taken to widen blood vessels – relax the ring of muscle between the oesophagus and stomach. This allows acid to leak back up.

Non-steroidal anti-inflammatory drugs (NSAIDs), such as aspirin and ibuprofen, can also affect your digestive tract and cause indigestion. 

Don’t take NSAIDs if you have stomach problems, such as a stomach ulcer, or you’ve had problems in the past. Children under 16 shouldn’t take aspirin.

Obesity

If you’re overweight or obese, you’re more likely to get indigestion. This is because increased pressure inside your stomach, particularly after a large meal, can cause acid reflux.

Pregnancy

Indigestion in pregnancy is partly caused by hormonal changes, and by the growing womb pressing on your stomach in the later stages of pregnancy.

As many as 8 out of 10 women experience indigestion at some point during their pregnancy.

Smoking and alcohol

The chemicals inhaled in cigarette smoke may contribute to indigestion. They can cause the muscle between the oesophagus and stomach to relax, causing acid reflux.

Drinking excess amounts of alcohol can also increase your risk of getting indigestion. Alcohol causes your stomach to produce more acid than normal, which can irritate your stomach lining.

Read more about the risks of drinking too much alcohol.

Stress or anxiety

Stress or anxiety can sometimes contribute to the symptoms of indigestion. Find out about breathing exercises for stress.

Hiatus hernia

A hernia occurs when an internal part of the body pushes through a weakness in the surrounding muscle or tissue wall.

A hiatus hernia is where part of the stomach pushes up into the diaphragm, the sheet of muscle under your lungs. This can cause acid reflux.

Helicobacter pylori (H. pylori) infection

Helicobacter pylori infections are common. They sometimes lead to stomach ulcers, although in most cases they don’t cause any symptoms at all.

Some people may get episodes of indigestion after having an H. pylori infection. In these cases, treating the infection with antibiotics will help.

Gastro-oesophageal reflux disease (GORD)

Gastro-oesophageal reflux disease (GORD) is a common condition and one of the main causes of recurring indigestion.

It occurs when the muscle between the oesophagus and stomach fails to prevent stomach acid rising into the oesophagus.

A small amount of acid reflux is normal and rarely causes problems. But in GORD a large amount of reflux causes the sensitive lining of your oesophagus to become inflamed.

This is caused by repeated irritation from stomach acid, and can cause heartburn, the sensation of bringing fluid back up, and painful swallowing.

Stomach ulcers

A stomach ulcer is an open sore that develops on the inside lining of your stomach (gastric ulcer) or small intestine (duodenal ulcer). Indigestion may be a symptom if you have a stomach ulcer.

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.

Stomach cancer

In rare cases, recurring bouts of indigestion can be one of the symptoms of stomach cancer.

Cancerous cells in the stomach break down the protective lining, allowing acid to come into contact with the stomach wall.

When to see your GP

There’s usually no need to seek medical advice for indigestion as it’s often mild and infrequent and specialist treatment isn’t required.

However, you should see your GP if you have recurring indigestion and any of the following apply:

These symptoms may be a sign of a more serious underlying health problem, such as a stomach ulcer or stomach cancer.

Also see your GP if you get indigestion regularly, if it causes you severe pain or discomfort, or if your regular anti-reflux remedies stop working.

Your GP will ask you about your symptoms and:

• any other symptoms you have that may indicate an underlying health condition
• any medication you’re taking – as some medications can cause indigestion
• your lifestyle – some lifestyle factors, such as smoking, drinking alcohol or being overweight, can cause indigestion 

Your GP may also press gently on different areas of your stomach to see if this is painful and whether any of your internal organs are swollen.

Further investigations

Depending on your symptoms, your GP may want to investigate further.

This is because indigestion can sometimes be a symptom of an underlying condition, such as a Helicobacter pylori (H. pylori) bacterial infection, a stomach ulcer, or stomach cancer.

Your GP may refer you for a procedure called an endoscopy to rule out a more serious cause of your indigestion.

During an endoscopy, a thin, flexible tube with a light and camera at one end called an endoscope is used to examine the inside of your body.

Taking certain medicines for indigestion can hide some of the problems that could otherwise be spotted during an endoscopy.

This means that for at least two weeks before having an endoscopy you’ll need to stop taking proton pump inhibitors (PPIs) and h3-receptor antagonists. 

Your GP may also recommend changing other medications that may be causing your indigestion.

However, you should only stop taking medication if your GP or another healthcare professional in charge of your care advises you to do so. 

Diagnosing H. pylori infection

If your GP thinks your symptoms may be caused by an H. pylori infection, you may need to have a test for it.

This may be a:

• stool antigen test – where a pea-sized stool sample is tested for H. pylori bacteria
• breath test
• blood test – a blood sample will be tested for antibodies to H. pylori bacteria

Antibiotics and PPIs can affect the results of a urea breath test or stool antigen test.

These tests may therefore 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

You may need further tests to rule out other underlying conditions that could be causing your indigestion symptoms.

For example, abdominal pain and discomfort can be caused by conditions that affect the bile ducts in your liver.

Bile ducts are tubes that carry bile from the liver to the gallbladder and bowel. Bile is a digestive fluid that breaks down fats, and the gallbladder holds bile.

Your GP may suggest you have a liver function test, a blood test used to assess how well your liver is working.

You may also need to have an abdominal ultrasound scan, which uses high-frequency sound waves to create an image of the inside of your body.

Treating indigestion

Treatment for indigestion will vary depending on what’s causing it and how severe your symptoms are.

Most people are able to manage their indigestion by making simple diet and lifestyle changes, or taking medication such as antacids.

See treating GORD if you’ve been diagnosed with gastro-oesophageal reflux disease (GORD). See treating a stomach ulcer if you’ve been diagnosed with a stomach ulcer.

Diet and lifestyle changes

It may be possible to ease your indigestion symptoms by making a few simple changes to your diet and lifestyle, such as those discussed below.

Losing weight can help if you’re overweight. It’s important to lose weight safely and steadily through regular exercise and by eating a healthy, balanced diet.

Avoid foods that seem to make your indigestion worse, such as rich, spicy and fatty foods. You should also cut down on caffeinated drinks, such as tea, coffee and cola, as well as alcohol.

Smoking can also contribute to indigestion, so speak to your GP or pharmacist about giving up smoking if you smoke. You can also call the NHS Stop Smoking Helpline on 0300 123 1044.

If you tend to experience the symptoms of indigestion at night, avoid eating for three to four hours before you go to bed.

Going to bed with a full stomach means there’s an increased risk that acid in your stomach will be forced up into your oesophagus while you’re lying down.

When you go to bed, prop your head and shoulders up with a couple of pillows, or raise the head of your bed by a few inches by putting something underneath the mattress.

The slight slope should help prevent stomach acid moving up into your oesophagus while you’re asleep.

Changing medication

If your GP thinks the medication you’re taking could be contributing to your indigestion, they may recommend changing it.

Where possible, your GP will prescribe an alternative medication that won’t cause indigestion.

Immediate indigestion relief

Antacid medicines and alginates can be recommended or prescribed by your GP for immediate relief.

Antacids

Antacids are a type of medicine that can provide immediate relief for mild to moderate symptoms of indigestion.

They neutralise the acid in your stomach, making it less acidic, so it doesn’t irritate 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 don’t take too much.

It’s best to take antacids when you’re expecting symptoms of indigestion, or when they start to occur, such as after meals or 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 considerations when using 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, when stomach acid leaks back up into the oesophagus, irritating 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 GP may recommend taking an antacid that contains an alginate if you experience symptoms of acid reflux or if you have GORD.

Antacids containing alginates should be taken after eating as this helps the medicine stay in your stomach for longer. Taking alginates on an empty stomach will result in them leaving your stomach too quickly for them to be effective.

Persistent indigestion

If you have persistent or recurring indigestion, treatment with antacids and alginates may not be effective enough to control your symptoms.

Your GP 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) and h3-receptor antagonists.

Proton pump inhibitors (PPIs)

Proton pump inhibitors (PPIs) restrict the acid produced in your stomach. They are taken as tablets and are usually only available on prescription.

If you’re over 18, you can buy some types of PPIs over the counter in pharmacies, but these should only be used for short-term treatment. See your GP if your indigestion is persistent.

PPIs may enhance the effect of certain medicines. If you’re prescribed a PPI, your progress will be closely monitored if you’re also taking other medication, such as:

• warfarin – a medicine that stops blood clotting
• phenytoin – a medicine to treat epilepsy

If you’re referred for an endoscopy, you’ll 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, but they’re usually mild and reversible.

Side effects may include:

h3-receptor antagonists

h3-receptor antagonists are another type of medication that your GP may suggest if antacids, alginates and PPIs haven’t been effective at 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 famotidine and ranitidine are available to buy over the counter in pharmacies. h3-receptor antagonists are taken either in tablet or liquid form.

As with PPIs, you’ll need to stop taking h3-receptor antagonists at least 14 days before having an endoscopy. This is because they can hide some of the problems that could otherwise be spotted during the procedure.

Helicobacter pylori (H. pylori) infection

If your indigestion symptoms are caused by an H. pylori infection, you’ll need treatment to clear the infection from your stomach.

This should help relieve your indigestion, as 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, where treatment involves taking three different medications.

Your GP will prescribe a course of treatment consisting of:

You’ll need to take these medicines twice a day for seven days. You must follow the dosage instructions closely to ensure the triple therapy is effective.

One course of triple therapy is effective at clearing an H. pylori infection in up to 85% of cases. However, you may need more than one course of treatment if it doesn’t clear the infection the first time.

Complications of indigestion

In some cases, severe indigestion can cause complications.

Oesophageal stricture

If the lining of the oesophagus is severely irritated over time by acid reflux, the oesophagus may become scarred. 

The scarring can eventually lead to your oesophagus becoming narrow and constricted – an oesophageal stricture.

If you have oesophageal stricture, you may have symptoms such as:

• difficulty swallowing (dysphagia)
• food becoming lodged in your throat
• chest pain

Surgery to widen the oesophagus is often needed to treat oesophageal stricture.

Pyloric stenosis

Like oesophageal stricture, pyloric stenosis is caused by long-term irritation of the lining of your digestive system by stomach acid.

Pyloric stenosis occurs when the passage between your stomach and your small intestine – the pylorus – becomes scarred and narrowed. This causes vomiting and prevents any food you eat being properly digested.

In most cases, pyloric stenosis is treated using surgery to return the pylorus to its proper width.

Barrett’s oesophagus

Repeated episodes of gastro-oesophageal reflux disease (GORD) can lead to changes in the cells that line your lower oesophagus. This is a condition known as Barrett’s oesophagus.

It’s estimated 1 in 10 people with GORD will develop Barrett’s oesophagus. Most cases affect people aged 50 to 70 – the average age at diagnosis is 62.

Barrett’s oesophagus doesn’t usually cause noticeable symptoms other than those associated with GORD.

However, it is a pre-cancerous condition. This means that while the cell changes aren’t cancerous, there’s a small risk they could develop into “full blown” cancer in the future, resulting in oesophageal cancer.

Page last reviewed: 21/09/2016

Next review due: 21/09/2019

Gastroesophageal Reflux Disease Symptoms, Diagnosis & Treatment

Overview

Gastroesophageal reflux disease (GERD) is a digestive disorder that occurs when acidic stomach juices, or food and fluids back up from the stomach into the esophagus. GERD affects people of all ages—from infants to older adults.

People with asthma are at higher risk of developing GERD. Asthma flare-ups can cause the lower esophageal sphincter to relax, allowing stomach contents to flow back, or reflux, into the esophagus. Some asthma medications (especially theophylline) may worsen reflux symptoms.

On the other hand, acid reflux can make asthma symptoms worse by irritating the airways and lungs. This, in turn, can lead to progressively more serious asthma. Also, this irritation can trigger allergic reactions and make the airways more sensitive to environmental conditions such as smoke or cold air.

Symptoms & Diagnosis

Symptoms

Everyone has experienced gastroesophageal reflux. It happens when you burp, have an acid taste in your mouth or have heartburn. However, if these symptoms interfere with your daily life it is time to see your physician.

Other symptoms that occur less frequently but can indicate that you could have GERD are:

•    Acid regurgitation (retasting your food after eating)

•    Difficulty or pain when swallowing

•    Sudden excess of saliva

•    Chronic sore throat

•    Laryngitis or hoarseness

•    Inflammation of the gums

•    Cavities

•    Bad breath

•    A recurrent or chronic cough

•    Chest pain (seek immediate medical help)

Diagnosis

Several tests may be used to diagnose GERD including:

•    X-ray of the upper digestive system

•    Endoscopy (examines the inside of the esophagus)

•    Ambulatory acid (pH) test (monitors the amount of acid in the esophagus)

•    Esophageal impedance test (measures the movement of substances in the esophagus)

Treatment & Management

If you have both GERD and asthma, managing your GERD will help control your asthma symptoms.

Studies have shown that people with asthma and GERD saw a decrease in asthma symptoms (and asthma medication use) after treating their reflux disease.

Lifestyle changes to treat GERD include:

•    Elevate the head of the bed 6-8 inches

•    Lose weight

•    Stop smoking

•    Decrease alcohol intake

•    Limit meal size and avoid heavy evening meals

•    Do not lie down within two to three hours of eating

•    Decrease caffeine intake

•    Avoid theophylline (if possible)

Your physician may also recommend medications to treat reflux or relieve symptoms. Over-the-counter antacids and h3 blockers may help decrease the effects of stomach acid. Proton pump inhibitors block acid production and also may be effective.

In severe and medication intolerant cases, surgery may be recommended.

Find out more about asthma.

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Using indigestion tablets to neutralise an acid | Experiment

Burettes are expensive and require a certain amount of skill to use. What follows here assumes that the class has been judged capable of doing this experiment using a burette.

The practical work should if possible start with the apparatus ready at each workplace in the laboratory to avoid vulnerable and expensive glassware (the burette) being collected from an overcrowded central location.

The experiment to test a single tablet should take no more than 25 minutes. If it is extended to compare the effectiveness of two or more brands of tablet, allow another 15–20 minutes per tablet. Different groups can be allocated one ‘standardisation’ brand of tablet to test, and one other brand, so that the class can compare a number of different brands in a one-hour lesson.

Equipment

Apparatus

• Eye protection
• Burette, 30 cm³ or 50 cm³ capacity (note 3)
• Conical flask, 100 cm³
• Beaker, 100 cm³
• Pestle and mortar
• Stirring rod
• Spatula
• Filter funnel, small (about 35 mm diameter)
• White tile (optional)
• Burette stand and clamp

Chemicals

• Dilute hydrochloric acid of appropriate concentration, 100 cm³ (note 4)
• Two different indigestion tablets – one from the standardisation brand to be tested by all groups, and one from a range of brands available to the class (note 5)
• Original packets from which the tablets are taken, together with price information for each packet
• Methyl orange indicator solution (or alternative) (note 6)
• Dionised or distilled water, about 100 cm³

Health, safety and technical notes

1. Read our standard health and safety guidance.
2. Wear eye protection.
3. If your school still uses burettes with glass stopcocks, consult the CLEAPSS Laboratory Handbook, section 10.10.1, for their care and maintenance. This experiment will not be successful if the burettes used have stiff, blocked or leaky stopcocks. Modern burettes with PTFE stopcocks are much easier to use, require no greasing, and do not get blocked. Burettes with pinchcocks of any type are not recommended; while cheap, they also are prone to leakage, especially in the hands of student beginners.
4. Dilute hydrochloric acid, HCl(aq) – see CLEAPSS Hazcard HC047a and CLEAPSS Recipe Book RB043. The concentration of hydrochloric acid should not need to be greater than 0.4 M. The concentration needed depends on the formulation of the tablets being tested. The aim is for each tablet tested to require around 20–30 cm³ of hydrochloric acid to neutralise. This can either be calculated from the tablet formulation if this is straightforward (some contain ingredients such as sodium alginate which make the calculation unreliable), or by running a test titration using an acid concentration of 0. 1 M. The latter result can then be used to calculate a suitable concentration.
5. Indigestion tablets – it is sensible to select brands of tablets for which a comparison is straightforward, with active ingredients restricted to carbonates, bicarbonates and/or hydroxides, avoiding those containing other active ingredients. A total of, say, four or five brands should be sufficient for an interesting exercise in comparing brands.
6. Methyl orange indicator – see CLEAPSS Hazcard HC032 and CLEAPSS Recipe Book RB000. The methyl orange indicator should be available in a dropper bottle on the teacher’s bench.

Procedure

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1. Crush a tablet using a pestle and mortar and carefully transfer it to a conical flask, using a spatula to ensure complete transfer as far as possible. Rinse any remaining fragments into the flask with a few cm³ of deionised water.
2. Add about 25 cm³ of deionised water to the flask, followed by three drops of methyl orange indicator.
3. Using a small funnel, pour a few cm³ of the dilute hydrochloric acid provided into the burette, with the tap open and a beaker under the open tap. Once the tip of the burette is full of solution, close the tap and add more of the solution up to the zero mark. (Do not reuse the acid in the beaker – this should be rinsed down the sink.)
4. Add acid from the burette into the flask, 1–2 cm³ at a time, while slowly swirling the flask. Continue to add the acid until a red colour begins to be seen in the flask that quickly returns to yellow-orange.
5. When it begins to take longer for this to happen, add a smaller quantity of acid at a time – eg 0.5 cm³ – until you reach a point where the red colour remains after one minute.
6. Record the volume of acid used.
7. Rinse the flask with water, and repeat the experiment with a different indigestion tablet. Refill the burette, if necessary.

Teaching notes

Titrating a powdered tablet containing insoluble ingredients such as calcium carbonate, magnesium carbonate and magnesium hydroxide is slow, as you need to allow for the solid to react with the acid. If the tablets have been pretested for their expected titre values, students can be instructed to add acid from the burette rapidly to a point 5 cm³ below the lowest expected value for the brands being tested – this should save time.

The experiment is designed to raise ‘fair test’ principles for discussion, and students are expected to comment with rational arguments on the validity of the comparisons they make. In particular, and if possible without prompting, they ought to read the instructions on each packet concerning the recommended dosage. Many comparisons are likely to be ‘grey’ rather than ‘black and white’. This could lead to suggestions for further investigations for improving comparisons, but it is unlikely that these will be feasible at school.

This experiment is likely to be more useful in investigative-style work for 14–16 year olds, rather than illustrating the development of understanding of the concept of acidity. However, this experiment enhances such understanding for many students.

Student questions

1. Explain why each group is asked to test one tablet of the same brand, and one of another brand.
2. Use your results to draw what conclusions you can about the value represented by each brand.
3. Is this a fair way of comparing brands of indigestion tablet? Explain your answer.
4. From the list of active ingredients on the packets, write word equations for the reactions that take place in your flask during the titrations.
5. Write a symbol equation for at least one of the reactions that takes place in the flask.

Additional information

This is a resource from the Practical Chemistry project, developed by the Nuffield Foundation and the Royal Society of Chemistry. This collection of over 200 practical activities demonstrates a wide range of chemical concepts and processes. Each activity contains comprehensive information for teachers and technicians, including full technical notes and step-by-step procedures. Practical Chemistry activities accompany Practical Physics and Practical Biology.

The experiment is also part of the Royal Society of Chemistry’s Continuing Professional Development course: Chemistry for non-specialists.

© Nuffield Foundation and the Royal Society of Chemistry

Health and safety checked, 2016

90,000 Enteritis, gastritis, pancreatitis, constipation and other digestive problems in dogs

What are gastrointestinal (GI) tract diseases and indigestion?

Gastrointestinal disorders and diseases affect a dog’s stomach and intestines, causing pain and other health problems. Any disorder that impairs the digestion or absorption of food, or changes the rate at which it passes through the digestive tract, can be called a digestive disorder.Healthy digestion is essential for your dog to use the nutrients from the food they eat to build and renew body tissues and provide energy. Disorders of the gastrointestinal tract can lead to dehydration, acid-base and electrolyte imbalances and wasting, therefore it is important to recognize the signs of the disease in time and consult a veterinarian.

Types and causes of gastrointestinal diseases and digestive disorders in dogs

There are many different types of digestive disorders, so your veterinarian must do a thorough diagnosis to determine the exact cause of your dog’s problem.

Causes can range from eating anything other than dog food to food allergies and food intolerances, infection, or lack of digestive enzymes. Some breeds of dogs, such as Great Danes, German Shepherds, Golden Retrievers, and Collies, are more prone to certain digestive problems. The following diseases are most common:

Acute gastroenteritis. Inflammation, incl. against the background of infection, the gastrointestinal tract, especially the stomach and intestines.Acute gastroenteritis is usually short-lived and can be caused by the dog eating spoiled or rancid food, human food with a high fat content, or eating foreign objects (such as swallowing a toy), toxic plants, or if the dog has internal parasites (such as roundworm), food allergies or intolerances, she is stressed or eats something that is not intended for dog food.

Colitis. By definition, colitis is an acute or chronic inflammation of the lining of the colon. Most often, it can be caused by parasitism of the whipworm helminth, tumors or polyps, changes in the daily diet, allergies (including to food components), the presence of foreign objects and some other reasons. Colitis is most common in dogs under 5 years of age and causes inflammation of the colon wall, leading to frequent and painful bowel movements. Diarrhea may be accompanied by mucus and blood.

Constipation. This disorder has several causes, including lack of exercise, dehydration, and eating foods that are difficult to digest, such as bones, other foreign objects, or foods that are very low in fiber.

Diarrhea. Often caused by infections, internal parasites, stress, food changes, abuse of treats, eating table scraps, spoiled food and food waste, as well as dysfunctions of other organs and systems of the animal’s body.

Pancreatitis. Inflammation, incl. caused by an infection of the pancreas (an elongated gland located next to the stomach and duodenum, which secretes many digestive enzymes and hormones). The cause of pancreatitis is often unknown.

The main possible causes are: eating food or food from the table with a high fat content, various infections, trauma or bruising, as well as diseases of other organs and tissues.

Exocrine pancreatic insufficiency. This condition is characterized by weight loss, increased appetite, and a large amount of liquid bowel movements.

Violation of absorption processes in the small intestine. Inflammation of the small intestine impairs nutrient absorption and leads to frequent diarrhea, weight loss and loss of appetite.

Does my dog ​​have a digestive disorder?

The most common symptoms of indigestion are poorly shaped stools or diarrhea. If your dog has digestive problems, you may notice some or all of the following symptoms:

• Vomiting
• Regurgitation
• Flatulence
• Weakness
• Diarrhea or constipation

Chronic gastrointestinal disease can be a serious problem for a dog and requires careful diagnosis and treatment under the supervision of a veterinarian.

IMPORTANT. If your dog has diarrhea or vomiting, he may become severely dehydrated. Check with your veterinarian if you notice any of the above symptoms.

Treatment and the importance of proper nutrition

Digestive upsets are quite common and in most cases resolve within a few days. However, some dogs need long-term grooming as they suffer from regular or persistent digestive problems.
Your dog’s food can have a significant impact on the health of its gastrointestinal tract. Depending on the specific diagnosis and signs / symptoms, a number of different nutritional approaches may be recommended by the veterinarian.

The primary goal of dietary therapy is to relieve symptoms of vomiting and / or diarrhea in a dog. Veterinarians recommend feeding dogs with this condition easily digestible food to prevent irritation of the sensitive stomach and intestines. In addition, a diet high in fermentable and non-fermentable dietary fiber, combined with a moderate amount of fat, helps maintain proper intestinal function in your dog.It is also important to monitor your dog’s water balance during the recovery period to help him replenish any fluid deficits. Since some of your pet’s gastrointestinal upsets may be regular, long-term monitoring of their diet may be required.

To make an accurate diagnosis and discuss treatment options, always consult your veterinarian and ask him for recommendations on the best food for your dog’s digestive health.

Questions about digestive health to ask your veterinarian:

1. Are there foods to avoid to keep my dog’s digestive system healthy?
   • How can regular food (such as chocolate or candy) affect your dog’s health?
2. Would you recommend Hill’s Prescription Diet or Science Plan for my dog?
   • Inquire about special foods for your dog.
   • How much and how often should you feed your dog the recommended food.
   • Discuss what treats you can give your dog with the recommended food.
3. How quickly will I see signs of improvement in my dog’s condition?
4. Can you provide me with a written instruction or memo on digestive health in dogs?
5. What is the best way to contact you or your hospital if I have any questions (e-mail / phone)?
   • Ask if your pet needs follow-up.
   • Specify if a reminder letter or email notification will be sent.

90,000 Most common causes of gastrointestinal disorders

Contents:

Often, animals develop diseases associated with the work of the gastrointestinal tract (GIT). Today we will consider the top of the most common causes of gastrointestinal disorders.

What is a gastrointestinal disorder? And why is it scary?

Diseases of the gastrointestinal tract affect the entire body of the pet, which leads to pain and other problems. Any violation of the digestion and absorption of food is a gastrointestinal disorder.

Healthy digestion is important for your pet as it allows you to use nutrients from food to build and repair tissue and provide energy.

Disorders of the gastrointestinal tract lead to dehydration, acid-base and electrolyte imbalances and malnutrition, so do not ignore such problems and, when the first symptoms occur, show your pet to the veterinarian.

Common causes of gastrointestinal problems

1. Infectious diseases . They are provoked by the appearance of helminths, viruses, bacteria, fungal agents, protozoa. They are most often found in puppies and kittens. Babies have weak immunity, therefore, at the first signs of infectious diseases, it is better to consult a veterinarian.

2. Poisoning. Sometimes pets eat something that is not supposed to: household chemicals, poisonous plants, poisons on the street, prohibited foods left in an easily accessible place (chocolate, grapes, onions). Also, the pet can be poisoned by products spoiled due to improper storage.

4. Inflammatory diseases of the stomach and intestines. This group includes gastritis, ulcers, colitis. Without a veterinarian, examination and additional research, it is impossible to establish the true cause of their development.

5. Disorders of the GI microbiota are not uncommon. There are many reasons for such violations: stress, medication, poisoning, infections.These diseases often coexist with other gastrointestinal problems.

6. Pancreatitis is an inflammation of the pancreas, an organ near the stomach and intestines. A common cause of pancreatitis is eating too much fatty foods, especially table waste.

Important! A pet with pancreatitis may need to be hospitalized as it will die without treatment.

And these are not all the reasons for problems with the gastrointestinal tract. They have similar symptoms: vomiting, diarrhea, constipation, bloating, soreness in the abdomen. For quality treatment, it is important to establish the true cause of the disorder, so take your pet to your veterinarian at the first symptoms. He will prescribe treatment and a special diet for him.

Ask your veterinarian about Hill’s . These are the diets that are recommended for gastrointestinal problems. They contain the new ActiveBiome + technology. ActivBiome + is a unique combination of prebiotic fiber that helps to restore the gut microbiome in a short time.

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Functional stomach disorders – causes, symptoms, diagnosis and treatment

Functional stomach disorders are a number of pathologies that are associated with impaired motility and secretory function of the stomach without significant changes in the structure of the mucous membrane. Manifested by symptoms of dyspepsia (nausea, loss of appetite, periodic vomiting) and pain. To make a diagnosis, the following studies are carried out: fractional gastric intubation, esophagogastroscopy, electrogastrography, gastric X-ray, ultrasound of the abdominal organs. Treatment – conservative, includes drug therapy, diet therapy, correct diet.

General information

Functional stomach disorders are diseases in which the functioning of the organ (secretion, motility) suffers, but pathological changes do not affect its structure. In the future, both the disappearance of symptoms and a complete cure are possible, as well as the transition of the disorders into a more serious organic pathology. Mostly young people are affected, men are twice as likely as women.According to various estimates, functional stomach disorders account for from 1.5% to 58.8% of all gastroduodenal pathology. Such different assessments are due to the fact that when making a diagnosis, different approaches are used and adequate additional research is not always carried out. If you suspect a functional stomach upset, you should seek the advice of a gastroenterologist or therapist.

Functional stomach disorders

Causes of functional stomach disorders

Functional stomach disorders can be of primary or secondary origin. Factors causing the onset of primary disorders include irregular eating, dry food, abuse of fried or spicy foods. Violations can develop due to alcoholism, smoking, physical stress, work in hot workshops, bacterial infections and helminthic invasions, stress. Secondary disorders include conditions that have arisen against the background of chronic diseases of various organs of the digestive system, vegetative-vascular dystonia, diseases of the kidneys, heart and blood vessels, spine, foci of chronic inflammation or infection.

Irregular meals lead to a violation of the cyclic secretion of gastric juice, an excess of gastrointestinal hormones. Some dishes (fried, with a lot of hot spices) can irritate the gastric mucosa, and smoking, especially on an empty stomach, provokes the release of gastrin, which stimulates the production of digestive juices in the stomach. Stress and nervous disorders lead to impaired neuroendocrine regulation. In case of secondary functional disorders, the first place comes to the strengthening of the influence of the vagus nerve (parasympathetic system), which stimulates motor skills and secretion.

In most cases, with functional disorders of the stomach, motility suffers, the evacuation of solid contents to the lower gastrointestinal tract is impaired. The pain is associated with arrhythmic strong contractions of the walls, sometimes reverse peristalsis is observed. Often not only gastric motility is impaired, but also the motor function of the duodenum, weakness of the sphincters occurs. The secretion in the stomach increases, which causes heartburn and pain in the upper abdomen.

Classification of functional stomach disorders

Taking into account the causes of the pathology, functional stomach disorders are divided into primary and secondary.In addition, the following types of organ dysfunction are distinguished: hypersthenic, hyposthenic, normosthenic, asthenic. According to clinical signs, the following forms are distinguished: pain, dyspeptic, mixed.

There are also several special forms of functional stomach disorders, for example, acute gastric dilatation, aerophagia and habitual vomiting. When formulating a diagnosis, the type and form of the disease must be indicated.

Symptoms of functional stomach upset

Most of the symptoms of functional stomach upset are clearly associated with specific causes of the disease.Pain appears after errors in diet, stressful situations. Pain in the epigastrium or around the navel is localized. They are aching in nature, sometimes they can turn into acute intense pain. Also, patients complain of nausea, heaviness in the stomach after eating, heartburn. For aerophagia, rotten belching is typical. Sudden, recurring vomiting is characteristic of habitual vomiting syndrome.

A specific feature of the symptomatology in functional disorders of the stomach is its subjectivity and inconsistency.Patients’ complaints are often contradictory, not very specific, with an emotional connotation. Their behavior and appearance are characteristic. Patients have an asthenic constitution, they are emotionally labile. Most of them do not eat well, work or study a lot, and have various personality problems.

During a general examination, signs of vegetative-vascular dystonia are often revealed – pallor of the skin, cold extremities, rapid or labile pulse, increased sweating. On palpation, slight pain is found in the upper abdomen or around the navel.An important diagnostic criterion is the short duration of complaints. The disease should not last more than a year or one and a half. Otherwise, a more serious pathology should be suspected.

Diagnosis of functional gastric disorders

To study the characteristics of gastric secretion, fractional gastric intubation is performed. The method allows you to determine the volume of gastric juice, its acidity, the amount of free hydrochloric acid. Probing is performed on an empty stomach (study of basal secretion) and after stimulation with histamine or pentagastrin (stimulated secretion).A more modern method of studying secretory function is intragastric pH-metry. It allows you to evaluate the properties of gastric juice and the peculiarities of its secretion directly inside the stomach.

Esophagogastroscopy helps to identify motor changes in the activity of the stomach, such as cardiac insufficiency, spasm or insufficiency of the sphincters, increased peristalsis. The appearance and structure of the mucous membrane in functional disorders of the stomach are not changed, rarely show signs of inflammation.This technique allows for differential diagnosis with pathologies such as chronic gastritis, erosion and ulcers, stomach cancer.

Electrogastrography (EGG) is performed using a special apparatus – an electrogastrograph. It allows you to study the bioelectric activity of the gastric wall. Using this technique, the type of functional stomach upset (hypersthenic, atonic, normotonic) is determined. To study motility, X-ray of the stomach with barium contrast is also used, which makes it possible to assess the rate of evacuation of contents, the state of the sphincters, the tone of the walls, and the volume of the organ.

Treatment of functional stomach disorders

Therapy depends on the cause and degree of functional stomach disorders. It is recommended to change the mode and quality of food. Food should be taken 3-4 times a day, at least once a day there are hot liquid dishes. It is necessary to limit foods that can irritate the mucous membrane (too spicy seasonings, pickled and fatty foods, smoked meats of all kinds). Very often, dietary adjustments lead to a significant decrease or complete disappearance of symptoms, and drug treatment is not required.

If a patient has neurovegetative disorders, anticholinergics of non-selective sedative action are prescribed. Nervous system disorders can be corrected with sedative phytopreparations, small tranquilizers, such as diazepam, oxazepam. In more severe cases, antidepressants are prescribed.

Antispasmodics (drotaverine, papaverine) are prescribed to treat motor dysfunction and relieve pain. A good effect is given by anticholinergics and selective anticholinergics, sometimes patients are advised to take nitrates.With habitual vomiting syndrome, metoclopramide and domperidone are prescribed. Secretory disorders are corrected with selective anticholinergics (pirenzepine, telenzepine), antacids.

Prognosis for functional stomach disorders

With functional stomach disorders, the prognosis is quite favorable. The main requirement is to make a correct diagnosis and start treatment on time. It is very important for the patient to change the type of diet, rest more and not overload the nervous system.If the disease occurs at a young or adolescent age, it can go away on its own after a year or two, when the neurovegetative system begins to work more stable, the disorders associated with age-related changes will be eliminated.

Under unfavorable circumstances, functional stomach disorders turn into more serious diseases – stomach ulcers, chronic gastritis. This happens in the absence of treatment, regular dietary disorders, stress. Sometimes the transition of functional disorders to organic ones is associated with infection or activation of Helicobacter pylori.Prevention of pathology consists in maintaining a balanced diet, work and rest, physical activity, and eliminating stress.

90,000 Bipolar disorder (BAD), its signs, types and treatments

Manifestations of various emotions, a change in a person’s mood, manifestations of both sadness and joy are normal and depend on many factors – from temperament and character to events that occur from outside.However, when these changes are excessive, often occurring unexpectedly and for no apparent reason, emotions get out of control, or the person remains in a cardinally positive or negative frame of mind for a long time, bipolar disorder is more likely to be diagnosed. This disease was first described at the end of the 19th century by the famous German psychiatrist Emil Kripelin, who called it manic-depressive psychosis. Many world famous personalities such as Vincent Van Gogh, Isaac Newton, Ludwig van Beethoven, Abraham Lincoln suffered from this ailment.The pronounced form of this disease, which in the international classification of diseases is called bipolar affective disorder (BAD), is detected in 3% of the world’s population.

CONTENTS OF ARTICLE

Often, a complex method is used in the treatment of women, which combines drug therapy and cognitive-behavioral or interpersonal therapy with a psychotherapist.

Bipolar Personality Disorder – Overview

According to statistics, bipolar disorder affects people from 14 to 44 years old.Unlike adults, children and adolescents experience more frequent mood swings from mania to depression, sometimes several times a day. 90% of young people make their debut precisely from the phase of depression or melancholy. Another feature of bipolar disorder is that, due to the low level of diagnosis, the patient can live with this disease for 5-10 years without knowing the cause of the painful symptoms.

Bipolar disorder is most often diagnosed in people whose immediate family members have had a similar problem.The causes of this disease are unknown, but stress, overstrain, and various diseases can provoke the manifestation of its symptoms. However, having fenced off a person from the influence of these factors, it is impossible to get rid of the problem; you need to seek help from a psychotherapist.

Bipolar disorder is a disease that cannot be completely eradicated. But with properly selected drug treatment and psychotherapy, the quality of life is significantly improved and the periods between phases are lengthened.The person remains socialized and able to work.

Symptoms and signs

From the name it is clear that we are talking about two different poles of affective manifestations, that is, manifestations of mood. One of these conditions is depression. Depression in bipolar disorder is pronounced, with vivid symptoms. It can last up to a year and is manifested not only by a low mood, a lack of the ability to take pleasure and interest in current events, but also psychosis, when ideas of self-accusation arise, the patient feels inferior, unnecessary, poisoning the life of others.Also, nihilistic thoughts about suffering some kind of serious illness are inherent, despite medical evidence to the contrary. Delusional thoughts can also occur, as well as suicidal thoughts and even attempts.

Another pole of bipolar disorder is a hypomanic state or hypomania, the characteristic signs of which are an increased euphoric emotional background, the patient is constantly in motion, hyperactive, characterized by very fast, associative speech. The patient is constantly cheerful, often hypersexual, almost always awake or asleep 2-3 hours a day.

Hypomania is often followed by a manic bipolar state with psychotic manifestations. The patient develops convictions of his own greatness, he believes that he is capable of anything, feels that he has a special calling in this world or that he is a descendant of great people. In detailed manic episodes of mania with psychotic manifestations, anger, irritability, and direct aggression often occur. This condition leads the patient into extremely unpleasant and sometimes dangerous situations.

In addition to the typical symptoms of the disease, there are a large number of comorbid mental disorders. Mental disorders that accompany the underlying disease are called comorbid ones. The most common disorder of this kind is anxiety, which is manifested, among other things, by nonspecific autonomic symptoms, including sweating, palpitations, tremors of the extremities, various disorders of the gastrointestinal tract, dizziness, headaches, choking, and many others.In the case when these signs appear suddenly, mainly in public places, they are usually called panic attacks.

Do you need expert advice?

Types of bipolar disorder

Bipolar disorder can be of types Ι and ΙΙ.

Type bipolar disorder is a condition in which the patient has persistent manias, that is, overexcitement, ecstatic inappropriate behavior, manic psychosis, as well as severe depression.Symptoms of this type are more severe and hospitalization is indicated in most cases.

Bipolar disorder is characterized by short periods of hypomania followed by periods of major depression. Hypomania is a pre-manic state with less active manifestations. Hypomania lasts a very short period of time – from several days to several hours, so sometimes patients do not even notice them and do not inform the doctor about it. Only careful, painstaking work with the patient can reveal hypomania, make the correct diagnosis and prescribe treatment.

Sboeva Elena Mikhailovna

Doctor-psychotherapist of the highest category

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Sboeva Elena Mikhailovna

Doctor-psychotherapist of the highest category

Make an appointment

Sboeva Elena Mikhailovna

Doctor-psychotherapist of the highest category

Make an appointment

Phases of bipolar disorder

Bipolar personality disorder has several phases:

1. Depressive (unipolar depression).People experience depressed mood, despair and discouragement, complain of lack of energy and mental concentration, can eat and sleep too much or very little.

At the peak of bipolar depressive disorder, depersonalization and derealization may occur. The boundaries of their own “I” and the world around them become blurred, patients experience difficulties in perceiving what is happening. Familiar places seem new, the color scale of the surrounding world changes, the patient constantly experiences a feeling of “déjà vu”.Sounds become muffled, even if someone speaks very close, it seems to the patient that the voice comes from afar.

2. Manic (hypomanic). In this state, patients are full of energy, overly happy or optimistic, euphoric and have extremely high self-esteem. At first glance, these are positive signs, but when a person experiences large-scale manic episodes, these symptoms and such an emotional state can go to dangerous extremes. A patient in this phase may indiscriminately spend huge amounts of money or behave inadvertently without realizing the full danger.In conversation, people can choke on words, speak at high speed, or jump from one thought to another. These episodes can also be accompanied by delusions of grandeur or making serious decisions without thinking about the further consequences.

In the development of the manic phase, the following stages of development can be distinguished:

• Hypomania – increased excitement, emotional uplift.
• Mania – all signs are more pronounced, aggression, irritability, irascibility and rage are possible.
• Peak phase. The patient is constantly experiencing nervous excitement, he cannot relax. All his emotions are “heated” to the limit, coordination of movements is disturbed, thoughts are illogical and abrupt, in speech he constantly jumps from one sentence to another.
• Relief of symptoms. The patient gradually calms down. Movement disorders are declining. Thinking speed and heightened emotional mood remain unchanged.
• Return to normal.

3. Mixed. Sometimes people have complaints that are characteristic of both depression and mania at the same time. They may also experience frequent phase changes — 4 or more episodes over a one year period.

In the intervals between the depressive and manic phases in bipolar disorder, there is a light interval during which the general background of mood becomes relatively stable, the person continues to adequately respond to certain events, the emotional sphere is under his control.This is the main criterion for remission of bipolar disease.

Bipolar disorder in women

According to statistics, type bipolar disorder occurs with the same frequency in men and women, and type disease is more often diagnosed in women. It is also known that the female course of the disease is characterized by fast cycles and mixed episodes. Comorbid conditions are often eating disorders, borderline personality disorder, alcohol or drug dependence, and drug abuse.Women are more susceptible to such somatic diseases as migraine (intense headaches), thyroid pathology, diabetes, obesity.

For women, a special technique is being developed to alleviate this disorder, since from adolescence to menopause there is a specificity of hormonal changes that must be taken into account. In addition, psychotropic substances, which are supposed to stabilize the condition, can adversely affect the intrauterine development of the fetus if a woman is in a position.It is noted that in the first trimester of pregnancy, this disorder is milder, but after childbirth, they often have to deal with postpartum depression. Thus, at each stage of the development of the female body, a competent doctor must revise and adjust the treatment regimen. Often in the treatment of women, a complex method is used that combines drug therapy and cognitive-behavioral or interpersonal therapy with a psychotherapist. This approach gives the fastest results.

Treatment for bipolar personality disorder

Attempts to get rid of bipolar disorder on their own do not bring the desired result and, ultimately, lead to an aggravation of the situation, including the development of drug or alcohol dependence. Keeping a mood diary can help in diagnosing the disease, where the patient records all his thoughts, emotions, feelings, changes in mood. Such records will help the doctor to assess in detail the mental state and make the correct diagnosis.If you suspect bipolar disorder, you should consult a doctor, and the sooner a person realizes that he has a disease and comes to the clinic for help, the sooner he will be provided with professional help and painful symptoms will be replaced by a stable state. It is impossible to get rid of the disease on its own, since a person cannot fully adequately assess not only his actions, but also the alternation of the phases of the disease.

Bipolar disorder is one of the few mental disorders in which drug treatment is indicated in 100% of cases, and psychotherapy is an auxiliary tool.This disease is incurable, but its diagnosis and treatment is extremely important. Treatment can reduce the number of episodes, their severity and intensity, as well as prevent negative events in life, help prevent breakups, job losses, and even suicidal attempts. Thus, the quality of life of a patient with bipolar disorder who is being treated will be several times higher than that of a person who neglects treatment. If the patient loses touch with reality and harms himself and others, he is subject to hospitalization, outpatient treatment in this case is not permissible.

If you have a disease, it is recommended to exclude coffee, strong tea, alcoholic and energy drinks from your diet in order not to provoke an over-excited state. If possible, you should stop smoking and in no case take even light drugs. It is also very important to establish a sleep schedule, sleep at least 8 hours a day and try to go to bed at about the same time. Learn to recognize mood swings and notice early onset of new episodes.

If you suspect you have bipolar personality disorder, you do not need to panic, only a doctor can diagnose the disease, so you need to make an appointment with a psychotherapist with extensive experience in managing such patients at our MedAstrum clinic. If the diagnosis is confirmed, the doctor will draw up the necessary drug treatment, if necessary, appoint psychotherapeutic sessions and give recommendations for further adjusting the lifestyle. You can make an appointment on your own on the website or by contacting our administrators.

90,000 Psychotherapy in the treatment of panic disorder with or without agoraphobia

Why is this review important?

Many people suffer from panic disorder. Panic disorder can occur on its own or in combination with agoraphobia. People with panic disorder have periodic panic attacks. During a panic attack, people experience a sudden feeling of intense fear, accompanied by the following symptoms: palpitations, chest pain, sweating, trembling, dizziness, redness, indigestion, weakness / fainting, and shortness of breath.People with agoraphobia have a strong fear of developing a panic attack when getting out is difficult or uncomfortable. This fear makes them avoid situations like this.

There are many types of talking therapy [“talking therapy”] that are used to treat panic disorder with or without agoraphobia. However, it is not clear if any particular type of talking therapy is more effective than others in treating panic disorder with or without agoraphobia.In this review, we compared the effectiveness of different types of talking therapy.

Who will be interested in this review?

People with panic disorder with or without agoraphobia.

Friends and relatives of people with panic disorder with or without agoraphobia.

General practitioners, psychiatrists and psychologists.

Adult Psychiatric Professionals.

What questions does this review answer?

Are the included psychotherapies more effective and better tolerated than others in rapidly reducing symptoms of panic disorder / agoraphobia?

Can any of the included psychotherapies guarantee the best results one year after completion?

What studies were included in this review?

We searched medical databases up to March 16, 2015 for all studies (randomized controlled trials) of talking therapy for panic disorder with or without agoraphobia.To be included in this review, studies must have included people with an established diagnosis of panic disorder with or without agoraphobia.

We included 60 studies in this review. Of the included studies (with 3021 participants), 54 were used for quantitative analyzes. The review authors rated the overall quality of the studies as low to very low.

What does the evidence from this review suggest?

The results of the review indicate that talking therapy is generally more effective than no treatment.There was insufficient evidence to support any one type of talking therapy over others for treating panic disorder with or without agoraphobia in adults. However, there was some low-quality evidence in favor of cognitive behavioral therapy (CBT), psychodynamic therapy, and supportive psychotherapy, compared with other types of talking therapies, for short-term remission and short-term symptom relief. However, the results of relatively supportive psychotherapy should be viewed with caution, as there is insufficient evidence for this type of treatment.