Your get indigestion when the acid in your stomach flows bade up your esophegus (the pipe that goes from your mouth to your stomach) or when your stomach is irritated or inflamed. Most people have suffered from indigestion after a large meal at some time, and up to four in 10 adults suffer from heartburn each year. Although it's most common after meals, you can get indigestion at any time. Medically it is also known as dyspepsia.

If you have indigestion you may have the following symptoms:

• Pain, fullness or discomfort in the upper part of your abdomen or chest
• Heartburn
• Loss of appetite
• Feeling sick
• Flatulence (gas passed from your rectum), burping or belching

Indigestion has several causes. Depending on what's causing your indigestion, your
symptoms may go very quickly, come and go, or they may be regular and last a long
time.
The symptoms of indigestion may sometimes be caused by a serious underlying
condition.
You should visit your GP for advice if you have:

• unintended weight loss
• unexplained and continual indigestion symptoms for the first time and you are aged 55 or older
• severe pain, or the pain gets worse or changes

You need to seek urgent medical attention if you vomit blood, even if it's only present in
the vomit as specks of blood or blood that looks like coffee grains.

Your stomach produces a strong acid that helps digest food and protects you against
infection. A layer of mucous lines the stomach, esophagus and intestines to act as a
barrier against this acid. If the mucous layer is damaged, the acid can irritate the tissues
underneath.
Some of the following can trigger symptoms of indigestion:

• Drinking excess alcohol
• Smoking
• Stress and anxiety
• Medicines such as aspirin and anti-inflammatory medicines used to treat arthritis
• Eating certain foods can relax the valve (sphincter) at the join between your esophagus and stomach or cause direct irritation to the lining of your esophagus
• Not eating regular meals, as acid levels can build up if meals are missed

Heartburn
Heartburn is a burning pain caused by the stomach acid flowing back up your esophagus.
This is called reflux. The medical term for the condition is gastro-esophageal reflux
disease (GORD).
With heartburn, the sphincter at the top of your stomach doesn't work properly, allowing
reflux of the stomach acid.

Peptic ulcers
These are stomach (gastric) or duodenal ulcers which occur when either the lining of your
stomach or your duodenum is damaged and becomes inflamed.
Helicobacter pylori (H. pylori)
This is a bacterium that lives in the mucous layer of your stomach and can cause irritation
(gastritis). Most people acquire infection with these bacteria in early childhood and often
it doesn't cause any problems (they just 'carry' the bacteria).

Pregnancy
Many women suffer from indigestion during pregnancy. One reason for this is the baby
increases pressure against your stomach. This can then increase the chance of reflux.

Cancer
Cancer can also trigger symptoms of indigestion, but this is rare.

Your GP will ask about your symptoms and examine you. He or she may also ask you
about your medical history.
If lifestyle changes and medicines don't help, your GP may recommend further tests, such
as the ones listed below.

• Breathe tests or blood tests to detect the presence of H. pylori.
• A gastroscopy is a procedure used to look inside the esophagus, stomach and the first part of the small intestine (duodenum). During the gastroscopy you may have a biopsy which is a small sample of tissue. This will be sent to a laboratory for testing.
• A barium meal X-ray is a test that involves swallowing a drink containing barium (a substance which shows up on X-rays). X-ray images of your abdomen then show the inside of your bowel more clearly.

If these tests can't diagnose the problem, the following may be used to look at other
organs such as your liver, heart, gallbladder, pancreas, bowels or kidneys.

• An ultrasound uses sound waves to produce an image of the inside of your body or part of the body.
• A CT scan uses X-rays to make a three-dimensional image of the body or part of the body.
• An MRI scan uses magnets and radiowaves to produce images of the inside of your body.
• An electrocardiogram (ECG) is a test that measures the electrical activity of your heart to see how well it's working.
• Blood tests can help your doctor to check your general health. Your blood may also be tested to see whether it contains particular chemicals (markers), which are sometimes produced by cancer cells.

Self-help
There are a few things you can do to reduce your symptoms of indigestion including:

• Cutting down on fatty foods, tea, coffee and alcohol
• Stopping smoking
• Sleeping in a more upright position, propped up on a pillow (the action of gravity reduces reflux)
• Eating more than three hours before bed if you have a peptic ulcer
• Reducing your stress levels
• Not overeating, or eating too quickly

Medicines
Non-prescription medicines
You can buy a range of indigestion treatments from your pharmacist without a
prescription. Always read the patient information that comes with your medicine and if
you have any questions, ask your pharmacist for advice.
Antacids are medicines that can often relieve symptoms of indigestion by neutralizing
acid in your stomach. They usually contain magnesium or aluminium. Some antacids
contain an ingredient called an alginate which forms a barrier that floats on the top of
your stomach contents to prevent reflux.
Examples of antacid brands include Rennie and Mucogel, and many of the popular
antacid brands contain a mixture of more than one active ingredient. Side-effects of
antacids can include diarrhea and constipation.
If antacids don't work, or if you need to take large quantities of antacid medicines to
relieve your symptoms, your pharmacist may recommend H2 blockers. These work by
reducing the amount of acid that your stomach produces. Examples of H2 blockers are
famotidine and ranitidine.
Prescription-only medicines
If your symptoms continue after taking antacids or H2 blockers, your GP can prescribe
another type of medicine called proton pump inhibitors. These work by stopping your
stomach producing acid. Examples are omeprazole and lansoprazole.
Other medicines work by coating your stomach lining to protect it from the acid. These
include bismuth and sucralfate. However, these are used less often than H2 blockers and
proton pump inhibitors.
If you have an H. pylori infection, your GP may recommend having triple therapy to kill
off the bacterial infection. This is usually a course of a proton pump inhibitor combined
with two different antibiotics, taken for seven days.
Always ask your doctor for advice and read the patient information leaflet that comes
with your medicine.

Complementary therapies
Some people may find that talking therapies, such as cognitive behavioral therapy (CBT)
and psychotherapy may reduce the symptoms of indigestion. These types of treatments
can be expensive, and aren't usually provided on the NHS.

In most cases, indigestion is mild and only occurs occasionally. However, severe
indigestion can sometimes cause complications, some of which are outlined below.

Esophageal stricture
Indigestion is often caused by acid reflux, which occurs when stomach acid leaks back up
into your oesophagus (gullet) and irritates its lining (mucosa). If this irritation builds up
over time, it can cause your oesophagus to become scarred. This scarring can eventually
lead to your oesophagus becoming narrow and constricted (known as esophageal
stricture).
If you have esophageal stricture, you may have symptoms such as difficulty swallowing,
food becoming lodged in your throat, and chest pain. It is often treated using surgery to
widen your oesophagus.

Pyloric stenosis
Like esophageal stricture, pyloric stenosis is caused by long-term irritation of the lining
of your digestive system from stomach acid. Pyloric stenosis occurs when the passage
between your stomach and your small intestine (known as the pylorus) becomes scarred
and narrowed. This causes vomiting and prevents any food you eat from being properly
digested.
In most cases, pyloric stenosis is treated using surgery to return the pylorus to its proper
width.

Peritonitis
Chronic (long-term) indigestion can break down and infect the lining of your intestinal
tract (peritoneum), which is known as peritonitis. This usually occurs if there is a tear or
other damage to your peritoneum, which can be caused by repeated exposure to stomach
acid.
Peritonitis can be treated using surgery to repair the damage to your peritoneum, and
antibiotics may sometimes be used to clear the infection.

The best way to treat indigestion is to prevent it by avoiding the foods and situations that
seem to cause indigestion.
Keeping a food diary is helpful in identifying foods that cause indigestion. Here are some
other suggestions:

•  Eat small meals so the stomach does not have to work as hard or as long.
•  Eat slowly.
•  Avoid foods that contain high amounts of acids, such as citrus fruits and tomatoes.
•  If stress is a trigger for your indigestion, reevaluating your lifestyle may help to reduce stress. Learn new methods for managing stress, such as relaxation and biofeedback techniques.
•  Smokers should consider quitting smoking, or at least not smoking right before eating, as smoking can irritate the stomach lining.
•  Cut back on alcohol consumption because alcohol can irritate the stomach lining.
•  Avoid wearing tight-fitting garments because they tend to compress the stomach, which can cause its contents to enter the esophagus.
•  Do not exercise with a full stomach. Rather, exercise before a meal or at least one hour after eating a meal.
•  Do not lie down right after eating.
•  Wait at least 3 hours after your last meal of the day before going to bed.
•  Sleep with your head elevated (at least six inches) above your feet and use pillows to prop yourself up. This will allow digestive juices to flow into the intestines rather than to the esophagus.