What is indigestion?

An introduction to what indigestion is

Indigestion is a disorder of the digestive system.

The term basically means ‘poor digestion’ and is also referred to as dyspepsia, a word derived from dys (meaning bad) and peptikos (Greek for digestion).

Indigestion is a state that is familiar to most of us after we have eaten a bit too much. In these situations, symptoms are transient and resolve quickly. However, up to 40% of people in the developed world have repeated and more long-lasting symptoms of indigestion.

How does indigestion come about?

Symptoms of indigestion arise from the upper part of the digestive system which can be roughly defined as the mouth, oesophagus (gullet), stomach and duodenum. In general, problems arising from further down the digestive tract (such as constipation or IBS) will not be referred to as indigestion.

When you eat, food passes from the mouth, down the oesophagus and into the stomach. The stomach is a muscular organ which produces acid and digestive enzymes to help break down food we eat.

Stomach acid plays a very important role as it speeds up the action of the digestive enzymes. But it has to be secreted in the right amounts - too little acid means that food is not being digested well enough, and this can in itself give rise to bloating, excessive burping and other symptoms.

Secreting too much acid means that the delicate lining of the stomach can become irritated, inflamed and swollen, leading to pain and discomfort in the upper part of the digestive tract.

When do symptoms occur?

Although you can get indigestion at any time, symptoms of indigestion are most common either just before or after eating.

Some people are affected very infrequently by indigestion. Others suffer symptoms more persistently, experiencing pain every day.

What is heartburn?

Heartburn is a burning sensation felt behind the sternum or breastbone. This condition is not related to the heart, but gets its name because the pain arises from the oesophagus which lies close to the heart.

Severe cases of heartburn have been mistaken as angina or a heart attack – and conversely, some people suffering from these heart conditions may think that their symptoms are ‘only’ heartburn or indigestion.

Heartburn is caused by the acidic contents of the stomach escaping backwards and upwards to the lower part of the oesophagus causing irritation, inflammation and pain. This is also known as acid reflux.

Many women experience heartburn during the last stage of pregnancy – this comes about because the unborn baby increases the pressure inside the abdomen, presses against the stomach and forces acidic contents back up into the oesophagus.

What complications can I expect?

For approximately 70% of all patients experiencing indigestion, no disease can be found to explain the symptoms¹ and for them, indigestion is a minor complaint that can be easily self- treated with the use of indigestion remedies.

Complications of indigestion are not common, but may include:

• Interference with everyday activities. For example, if bending down gives you heartburn
• Weight loss, most often caused by poor appetite
• Stomach (gastric) ulcer. Also known as a peptic ulcer, this occurs when the acid in the stomach irritates the lining to the extent that an ulcer forms. It is associated with infection by a bacterium known as Helicobactor pylori
• Duodenal ulcer. Excessive acid in the stomach can also damage the lining of the next part of the digestive system
• Perforated ulcers. Both stomach and duodenal ulcers can be severe enough for the ulcers to break completely through the muscle wall, giving rise to a ‘perforation’. Contents of the digestive system spill into the abdominal cavity causing peritonitis – this is a life threatening situation
• Barrett’s oesophagus. This is caused by longstanding acid reflux, leading to changes in the structure of the cells of the lower part of the oesophagus – they start to resemble those that line the stomach. It can cause pain and vomiting
• Oesophageal stricture. Long-standing acid reflux can cause scarring and narrowing of the lower part of the oesophagus. This gives rise to difficulty in swallowing and pain
• Pyloric stenosis. In the same way, scarring can also occur at the outlet of the stomach, causing vomiting and preventing proper digestion of food you eat.

¹ Scottish Intercollegiate Guidelines Network available at http://www.sign.ac.uk/guidelines/fulltext/68/section7.html

When should I approach my doctor with indigestion?

Many people can manage their symptoms of indigestion without going to a doctor, particularly if symptoms are infrequent or mild. However, seek medical attention if you:

• Suspect an underlying medical condition such as an ulcer
• Are experiencing severe pain
• Experience unexpected or unexplained weight loss
• Are throwing up, particularly if there are specks of blood in your vomit or stool
• Are 55 years or over and have never experienced indigestion before
• Are experiencing complications associated with your indigestion
• Feel that medication you are taking is aggravating your symptoms of indigestion.