Dyspepsia

Dyspepsia

Introduction

Symptoms of indigestion

Causes of indigestion

Indigestion has a number of different causes, but it’s rarely due to a serious, underlying condition.

It’s normal for your stomach to produce acid, but sometimes this acid can irritate the lining of your stomach, the top part of your bowel (duodenum) or your gullet (oesophagus).

This irritation can be painful and often causes a burning sensation. Indigestion may also be due to the lining of your digestive system being overly sensitive to acid, or the “stretching” caused by eating.

Indigestion can also be triggered or made worse by other factors. Some of these are explained below.

Medications

You may have indigestion if you take certain types of medication. Some medicines, such as nitrates (taken to widen your blood vessels) relax the oesophageal sphincter (ring of muscle between your oesophagus and your stomach), which allows acid to leak back up.

Other medicines, such as non-steroidal anti-inflammatory drugs (NSAIDs), can affect your digestive tract and cause indigestion.

Do not take NSAIDs, such as aspirin and ibuprofen, if you have stomach problems, such as a stomach ulcer, or have had this in the past. Children under 16 years of age should not take aspirin.

Never stop taking a prescribed medication unless you are told to do so by your GP or another qualified healthcare professional who is responsible for your care.

Obesity

If you are very overweight, you are more likely to experience indigestion because of increased pressure inside your stomach (abdomen). 

The increased pressure, particularly after a large meal, may lead to acid reflux into the oesophagus.

Stress or anxiety

If you regularly experience feelings of stress or anxiety, this can contribute to symptoms of indigestion.

Read some relaxation tips to relieve stress.

Hiatus hernia

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

hiatus hernia occurs when part of your stomach pushes up into your diaphragm (the sheet of muscle under your lungs). It may partially block refluxed stomach acid clearing from your oesophagus, leading to heartburn.

Helicobacter pylori infection

Helicobacter infection is very common. It may lead to stomach ulcers or, rarely, stomach cancer. In most cases, however, it does not cause any symptoms at all.

Some people may get bouts of indigestion from helicobacter infection and, in these cases, getting rid of the bug with antibiotics (eradication) will help. However, many cases of indigestion are not caused by helicobacter, and in these cases eradication will not get rid of symptoms.

Gastro-oesophageal reflux disease (GORD)

Gastro-oesophageal reflux disease (GORD) is a common condition and one of the main causes of recurring indigestion. It’s caused by acid reflux, which occurs when the oesophageal sphincter fails to prevent stomach acid from moving back up into your oesophagus.

A little bit of acid reflux is normal and rarely cause any symptoms. It becomes GORD when large amounts of reflux occur, and the sensitive lining of your oesophagus may get inflamed by repeated irritation from stomach acid. This can lead to heartburn, the sensation of regurgitation or painful swallowing.

Stomach ulcers

stomach ulcer is an open sore that develops on the inside lining of your stomach (a gastric ulcer) or small intestine (a duodenal ulcer). If you have a stomach ulcer, you may have indigestion as a symptom.

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 (see above).

Stomach cancer

In rare cases, recurring bouts of indigestion can be a symptom of stomach cancer.

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

 

Diagnosing indigestion

For most people, indigestion (dyspepsia) is mild and infrequent, and does not require treatment from a healthcare professional.

However, if you have indigestion regularly, or if it causes you severe pain or discomfort, see your GP. 

They will ask about your indigestion symptoms, as well as:

  • any other symptoms you have – which may indicate an underlying health condition
  • any medication you are taking – as some medications can cause indigestion
  • your lifestyle – as 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 (abdomen) to establish whether or not this is painful.

Depending on the type of indigestion symptoms you have, your GP may want to investigate your condition further. This is because indigestion can sometimes be a symptom of an underlying condition or health problem, such as a Helicobacter pylori (H pylori) bacterial infection.

Details of some of the further investigations you may have are outlined below.

Further investigations

Endoscopy

You may be referred to hospital to have an endoscopy.

An endoscopy is a procedure used to examine the inside of your body using an endoscope  a thin, flexible tube, about the width of your little finger, with a light and a camera on one end. The camera is used to relay images of the inside of your body to a TV monitor.

An endoscopy is not often needed to diagnose indigestion, but your GP may suggest that you have one if:

  • they need to examine the inside of your abdomen in more detail
  • you have had treatment for indigestion that has not worked
  • you have any serious symptoms of indigestion 

Read more about having an endoscopy.

Taking certain medicines for indigestion can hide some of the problems that could otherwise be spotted during an endoscopy. Therefore, for at least two weeks before your endoscopy, you will need to stop taking proton pump inhibitors (PPIs) and H2-receptor antagonists. 

Read more about treatments for indigestion.

Your GP may also recommend changing other medications that may be causing your indigestion. However, only stop taking medication if you are advised to do so by your GP or another healthcare professional responsible for your care. 

Diagnosing H pylori infection

If your GP thinks that your symptoms may be due to an infection with H pylori bacteria, you may need to have a test for it, such as:

  • a stool antigen test  a pea-sized stool (faeces) sample will be tested for H pylori bacteria
  • a breath test
  • a blood test  a blood sample will be tested for antibodies to H pylori bacteria (antibodies are proteins produced by the body to fight infection)

Antibiotics and PPIs can affect the results of a urea breath test or a stool antigen test. Therefore, these tests may 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

If your GP thinks that your indigestion symptoms may be caused by another underlying medical condition, you may need to have some further tests to rule this out.

For example, abdominal pain and discomfort can also be caused by conditions affecting the bile ducts in your liver. Your bile ducts are a series of tubes that carry bile (fluid used by the digestive system to break down fats) from the liver to the gallbladder (a pouch that holds bile) and the bowel. If your GP thinks that you may have such a condition, they may suggest you have a liver function test, which is a type of blood test used to assess how well your liver is working.

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

Treating indigestion

Complications of indigestion

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

Oesophageal stricture

Indigestion is often caused by acid reflux, which occurs when stomach acid leaks back up into your gullet (oesophagus) and irritates its lining. If this irritation builds up over time, it can cause your oesophagus to become scarred. The scarring can eventually lead to your oesophagus becoming narrow and constricted (known as oesophageal stricture).

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

Oesophageal stricture is often treated using surgery to widen your oesophagus.

Pyloric stenosis

Like oesophageal 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.

Barrett’s oesophagus

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

It is estimated that 1 in 10 people with GORD will develop Barrett’s oesophagus. Most cases of Barrett’s oesophagus first develop in people aged 50-70 years old. The average age at diagnosis is 62.

Barrett’s oesophagus does not usually cause noticeable symptoms other than those associated with GORD.

The concern is that Barrett’s oesophagus is a pre-cancerous condition. This means that while changes in the cells are not cancerous, there is a small risk they could develop into “full blown” cancer in the future. This would then trigger the onset of oesophageal cancer.