Symptoms of indigestion, usually felt just below or behind the breast bone, vary from an uncomfortable feeling of fullness to nausea, pain, belching, heartburn and wind. Most people will suffer from indigestion from time to time. Often there is no recognisable pattern to the symptoms, but they may be noticeably worse just before or after a meal. Nearly one person in ten takes a remedy for some form of indigestion every day and of these one in three will have had symptoms for ten years or more. Three out of four sufferers never consult a doctor. The problem becomes more common after middle age, particularly in those who are overweight. Sensitive, anxious people are also more prone to indigestion, as anxiety increases the output of acid secretions in the stomach.
The most common form of indigestion is called heart-burn, an apt name as it well describes the symptoms – waves of burning pain behind the breast bone and sometimes a burning feeling in the throat. The pain can be mistaken for heart pain (angina), but in fact angina improves with rest, whereas heartburn is usually worse when the sufferer is lying down. It is easy to see why when we look more closely at what causes it.
The stomach produces strong acid secretions which help to digest and sterilise our food. The stomach lining has a mucous coating which protects it against the acid, but the oesophagus – the gullet down which food passes from the mouth to the stomach – does not. Normally a ring of muscle – the cardiac sphincter – at the bottom end of the oesophagus acts like a trapdoor and prevents acid rising up from the stomach. Sometimes, however – if the muscle becomes a little lax, for instance, as it often does during pregnancy -small amounts of acid will enter the lower part of the oesophagus – a process known as reflux. It is normal for this to happen occasionally and the saliva we are constantly swallowing will usually be enough to neutralise the acid without symptoms being caused. Also, contractions of the muscle walls of the gullet prevent the acid rising by keeping food and saliva moving downwards.
However, if reflux occurs too often, the oesophagus will gradually become inflamed and painful as the acid burns into the tissues. This inflammation is called oesophagitis. Without effective treatment the lining of the gullet can eventually become ulcerated and constricted by scarring so that swallowing food can be difficult. Other changes in the cells may also develop in time. It is important, therefore, to treat heartburn early on to prevent oesophagitis progressing.
Indigestion can have other causes – secretions such as pepsin (an enzyme which aids digestion) and bile from the liver (which helps digest fatty foods) are also capable of irritating the vulnerable stomach. Anxious people will often, unconsciously, swallow more air with their food and eat faster than others, causing distention, a rumbling stomach and belching. This type of indigestion may be relieved by learning techniques for relaxation (with the help of cassettes, for instance) and by eating smaller, more frequent meals, slowly.
Many people think that eating greasy, rich or spicy foods, or eating too much too quickly, are the main causes of heartburn. In fact, although these do play a part, smoking more than ten cigarettes a day and drinking heavily are the most common causes, as both of these relax the cardiac sphincter and therefore make reflux more likely. Bouts of indigestion are therefore sometimes a warning signal that the body is being abused – alcohol, especially on an empty stomach, and smoking both stimulate acid production and inflame the stomach.
Some drugs – antibiotics, iron tablets and aspirin, for example – can also inflame the oesophagus and cause heartburn, especially if they are taken with too little fluid or just before going to bed. Citrus fruits, chocolate, coffee and, perhaps surprisingly, peppermint are other possible culprits. Heartburn is also a common symptom of a hiatus hernia, whereby part of the stomach protrudes upwards at the point where the oesophagus passes through a gap in the diaphragm. A sensitivity to certain foods, such as sugar and milk, can also cause unpleasant indigestion, as can fatty foods for some people. Cutting down on stimulants and avoiding foods found to aggravate the symptoms will, in this case, usually relieve them.
Indigestion and heartburn are, of course, also common during pregnancy. Being overweight, large meals and lack of exercise are other predisposing factors. If indigestion or heartburn is worrying or persistent, a doctor’s examination and perhaps some special investigations may be necessary to exclude underlying causes such as hiatus hernia, peptic ulcer or gall bladder trouble.
When no such cause can be found, and in most cases of occasional indigestion, self-help measures can help. Don’t smoke or drink too much alcohol, coffee or acidic fruit drinks. Lose weight if necessary. It’s better to eat several small meals a day rather than one large one and to avoid eating just before going to bed. Eat slowly, sitting upright -not slouched in front of the television – and chew your food thoroughly before swallowing. Get used to bending down from the knees rather than from the waist and avoid stooping after meals. Don’t wear tight belts or corsets, as they increase pressure on the stomach.
If heartburn is troublesome at night, raise the head end of the bed about eight inches – two standard house bricks are about the right height. This helps to keep the acid down in the stomach and is much more effective than using extra pillows, because you will probably slide off these in your sleep. A glass of milk before bedtime helps, too.
Combined with these measures, a regular dose, in between meals, of an antacid medicine bought from the chemist should be all that is needed to ease indigestion. These medicines neutralise stomach acid, help prevent inflammation and relieve pain. Around £42 million were spent on indigestion remedies in the UK in 1990 and as you can imagine there are several different types – for example, aluminium hydroxide, calcium carbonate, magnesium hydroxide and sodium bicarbonate. Antacids can be combined with substances called alginates, which float on the contents of the stomach and stop the gastric juices splashing upwards (refluxing) and irritating the gullet, or with drugs to disperse wind.
Some antacids are more effective than others. Magne-sium hydroxide can take a while to have any effect but relief is fairly long lasting. Some remedies – those containing calcium, for instance – wear off quickly, and by over-neutralising the existing acid in the stomach, may have the rebound effect of actually stimulating further acid produc- tion. Also, the calcium and sodium salts contained in some antacid medicines will be absorbed into the bloodstream, and this is undesirable in the longer term.
Remember that all antacids can interfere with the absorption of other drugs, so check with your pharmacist if you are taking any other medicines. You will probably find that a particular brand of antacid will work better than others for your indigestion, so it will often be a case of trial and error.
Actal, Alka-Seltzer (for headache with upset stomach), Andrews Liver Salt, Andrews Answer (for headache with upset stomach), Andursil Tablets and Liquid, Asilone Tablets, Aludrox Tablets and Liquid, Bismag, Bisodol Powder and Tablets, Bisodol Extra, Dijex, Gastrils Antacid Pastilles, Gaviscon, Gelusil Tablets, Indigestion Lozenges, Lanes Charcoal Tablets, Milk of Magnesia, Mor-land, Premiums, Rennie, Rennie Gold, Rennie Plus
Carbo. Veg., Kali. Phos., Nux. Vom.