Digestive Issues



Indigestion is the term used to describe pain and discomfort in the upper abdomen or chest that can develop after a meal. The medical term for it is dyspepsia. Sometimes a burning feeling is felt in the chest, and this is known as heartburn. Most people have suffered from indigestion after a large meal at some time, and up to 20% of people suffer from heartburn at least once a week.
The upper digestive system
The upper digestive system
What are the symptoms?

The main symptoms of indigestion are:

* Pain, which may be in the upper part of the abdomen or the chest. This may not always be related to eating.
* Heartburn, a burning pain caused by reflux (regurgitation) of the stomach's contents back up the oesophagus (gullet). The medical term for the condition is gastrooesophageal reflux (GORD). The pain is normally felt in the centre of the chest or behind the sternum (breastbone). If severe, it can be hard to distinguish from a heart attack.
* Loss of appetite, nausea and vomiting.
* Flatulence, burping or belching.

Indigestion has several causes. Depending on the cause, the symptoms may occur for a short time only, they may return intermittently, or they may be regular and prolonged.

There are certain indigestion symptoms that could be associated with a serious underlying condition such as an ulcer (see the separate BUPA factsheet on stomach ulcers) or occasionally cancer. Anyone experiencing any of the following symptoms in addition to indigestion should get advice from their GP:

* unintended weight loss,
* new symptoms in anyone over 45 years old who has not previously suffered any indigestion problems,
* severe pain.

Urgent medical treatment is needed for anyone who experiences the following symptoms:

* vomiting with specks of blood or blood that looks like coffee-grounds,
* vomiting fresh, red blood.

What causes indigestion?

The stomach produces a strong acid that helps digest food and protects against infection. A layer of mucus lines the stomach, oesophagus and intestines to act as a barrier against this acid. If the mucus layer is damaged, acid can irritate the tissues below.

With heartburn, the sphincter (valve) at the join between the oesophagus and stomach does not work properly, allowing reflux of the stomach contents.

Some of the following things can make the symptoms worse:

* Eating a heavy meal.
* Drinking excess alcohol.
* Smoking.
* Irregular meals, because long gaps between meals allow the acid more time to act. Each meal neutralises the acid for a while.
* Stress and anxiety.
* Drugs such as aspirin and anti-inflammatory medication used to treat arthritis.
* Pregnancy, which commonly causes heartburn, indigestion or vomiting.
* Peptic ulcer (stomach ulcer), which is a raw patch in the lining of the stomach or the small intestine. See the BUPA factsheet, Stomach ulcer for more information.

Other causes:
Helicobacter pylori (H. pylori)

This is a bacterium, which lives in the mucus layer of the stomach, that can cause irritation (gastritis). It is present in about half the population, often without causing any symptoms. However, a high percentage of people who suffer from a stomach ulcer are found to carry the bug and about 15% of people who carry the bug will go on to develop an ulcer. It is possible that a small proportion of people who are affected will develop stomach cancer.

If H.pylori is diagnosed, it can be treated with a one week course of tablets (see Treatment, below).
Hiatus hernia

This occurs when part of the stomach slides through the diaphragm, which is the muscular sheet that separates the lungs and chest from the abdomen.

Normally, the stomach is completely below the diaphragm (see diagram at the top of this factsheet). But in some people, part of the stomach slides up into the chest cavity. This is called a hiatus hernia, and it causes pain and heartburn.

Hiatus hernia is most likely to occur in pregnant women and people who are overweight. If the symptoms are severe, it can be repaired by an operation.

A number of lifestyle changes may reduce the symptoms of indigestion. These include:

* dietary changes, such as reducing intake of fatty foods, tea, coffee and alcohol, and eating small regular meals,
* stop smoking,
* sleeping propped up on a pillow,
* reducing stress wherever possible.


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