Indigestion

Article written by Dr Ruth Dyson

Definition

Indigestion, also termed dyspepsia, is a feeling of discomfort or upper abdominal pain which is associated with eating. This can be felt as a sensation of burning (heart burn), or as a sensation of acid coming up into the oesophagus (reflux or gastro oesophageal reflux disease shortened to GORD). A hiatus hernia refers to where a portion of the stomach protrudes up through the diaphragm, when this occurs it makes reflux more likely.   

Prevalence

Indigestion is a common condition and most of us have experienced symptoms at some point for example after a heavy meal. It can, however, become frequent and troublesome for some people. The UK prevalence depends on the definition of dyspepsia used, and ranges from 12% to 41% (1)

Cause

Acid is essential for effective digestion of our food and protection from infections. But when acid or stomach contents comes up into the oesophagus it becomes a problem. This may occur for a number of reasons for example if there is too much or too little acid produced or if the circular muscle at the top of the stomach is weak. There can be serious underlying conditions which result in indigestion symptoms for example gastric or duodenal ulcers, oesophagitis and gastric cancer. It is therefore essential that you discuss your symptoms with your GP or specialist to rule out any underlying cause. The majority of people suffer "functional dyspepsia" where there is no identified cause. 

Symptoms and Signs

The symptoms of indigestion are familiar to most people and include upper abdominal pain, heart-burn, a sensation of acid reflux or regurgitation, nausea, bloating and wind. There are some  symptoms which can be a sign of more serious underlying disease and these include vomiting, difficulty swallowing and weight loss. If any of these occur it is essential that you inform your GP.

Investigations

Your GP may recommend blood tests (to check for anaemia or coeliac disease) and/or a test for H pylori. If there is any concern about a serious underlying condition then an endoscopy  may be recommended. Further tests may be recommended depeding on your condition such as monioring of the pH (acidity) within the oesophagus or medical imaging techniques. If there are no worrying symptoms then your condition may be managed without any testing. If conventional tests are normal then functional testing of the gut with a comprehensive stool or other test may be recommended by one of our practitioners. 

Management of indigestion

There is much that you can do to reduce symptoms with diet and lifestyle approaches. Reducing tea/coffee/fizzy drinks and avoiding alcohol, eating little and often, avoiding big meals especially later in the day, maintaining a healthy weight, avoiding rich or spicy foods and using over the counter remedies or peppermint tea can all be helpful.  Recoding food and symptoms diary for 4-14 days may be useful in identyfing trigger food or other factors. Stress can often worsen symptoms so relaxation techniques may help to reduce symptoms. There may be certain foods that cause a problem so a food/symptom diary and appropriate dietary interventions can help. Conventional treatment aims to reduce acid production with proton pump inhibitors (PPIs) e.g. omeprazole or H2 receptor agonists e.g. ranitidine, or to stop the stomach contents refluxing up with alginates e.g. Gaviscon.

What complementary and alternative therapies shall I try?

If diet/lifestyle interventions have not been helpful or you continue to struggle with symptoms despite conventional treatment then an assessment with one of our practitioners may be helpful. An assessment with a Nutritional Therapist or Integrated Medicine Doctor can help to identify possible causes and appropriate tests can be arranged if indicated. Treatments such as dietary interventions, supplements or homeopathic remedies may be helpful. Hypnotherapy can be very effective in any gut related disorder especially if there is an element of stress contributing. Acupuncture may also be helpful to manage the condition.

What practitioners can I see about this condition?

Follow up

After you initial consultation, we recommend that you have regular check-ups to monitor your symptoms and response to interventions. The practitioner will advise on appropriate follow up arrangements for your individual situation. 

Multidisciplinary approach

Our therapists work collaboratively and can share information to ensure you see the right practitioner for your condition. Depending on your needs, your care may be shared with other practitioners at the natural practice or elsewhere. Whenever you permit us, we will write to your GP to ensure they are aware of our recommendations and follow up arrangements.

Further information:

References

  1. NICE Clinical Guideline GC184 - Gastro-oesophageal reflux disease and dyspepsia in adults: investigation and management – 2014

 

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