Indigestion

Also called Dyspepsia, Heartburn

Very common and usually harmless. This entry is about the small number of times it is not.

What it is

Indigestion affects most people occasionally. Usually it is reflux or irritation of the stomach lining, and it responds to simple measures.

This entry exists for two reasons, and both are about what indigestion can be mistaken for.

The first is cardiac. A meaningful number of heart attacks are dismissed as indigestion, particularly by men who do not want to make a fuss and by women whose symptoms present atypically. New indigestion-like discomfort with sweating, breathlessness, or radiating to the jaw or arm should be treated as cardiac until proved otherwise. See heart attack.

The second is cancer. New indigestion in someone over 55, or indigestion with weight loss, difficulty swallowing or vomiting, needs urgent investigation for stomach or oesophageal cancer.

Everything else is usually straightforward.

Signs you might notice

Burning or discomfort in the upper abdomen or behind the breastbone.

Feeling full quickly, bloating, belching, nausea.

Worse after eating, and worse lying down.

Red flags that change the response: difficulty swallowing, persistent vomiting, unintentional weight loss, a lump in the abdomen, iron deficiency anaemia, or new symptoms over 55.

Cardiac features: sweating, breathlessness, pain spreading to the jaw, arm or back, or symptoms brought on by exertion.

How it can affect day-to-day life

Long-term acid suppression is extremely common and often continues without review for years. It is sometimes right, and it reduces absorption of B12, magnesium and calcium, so it needs a reason and a review date.

Non-steroidal anti-inflammatories such as ibuprofen are a very common cause and are bought over the counter, so nobody thinks of them.

Helicobacter pylori infection causes a substantial share of ulcers, is easily tested for, and is curable.

Supporting someone well

Know the two sets of red flags: cardiac, and cancer. Act on either.

Test for Helicobacter pylori rather than treating indefinitely with acid suppression.

Review any long-term acid suppression at least annually, and ask whether it can be stepped down.

Look at anti-inflammatories, including bought ones.

Eat earlier in the evening, raise the head of the bed, and identify personal triggers rather than following a generic list.

In someone who cannot describe symptoms, treat mealtime distress or refusing food as a possible pain signal.

Where to get help

A pharmacist can advise and treat, and a GP can test for H. pylori.

Same-day help for indigestion-like pain with sweating, breathlessness or radiation. Call 999 if in doubt.

Urgent GP appointment for difficulty swallowing, weight loss, vomiting, or new symptoms over 55.