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Health condition · Clinically reviewed

Indigestion, a stepped UK plan for dyspepsia that actually works.

Up to 40% of UK adults get indigestion each year. Most is functional dyspepsia; a smaller share is organic. This guide is the SEO companion to our full dyspepsia clinical page.

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Why trust this guide

  • 01

    Clinically reviewed

    Written by our editorial team and reviewed by a registered UK clinician before publication.

  • 02

    Sourced from guidance

    Checked against NICE NG184, the British Society of Gastroenterology and peer-reviewed sources you can see at the end.

  • 03

    Current for 2026

    Reflects modern UK practice including Rome IV functional dyspepsia, H. pylori test-and-treat and safer long-term PPI use.

Key facts

Indigestion at a glance.

The essentials in plain English - what it is, how common it is and how UK guidelines say it should be worked up and treated.

  • What it is

    Indigestion (dyspepsia) is upper-abdominal discomfort - burning, fullness, early satiety or bloating - centred on the epigastrium.

  • How common

    Up to 40% of UK adults get symptoms each year. Most is functional; a smaller share is organic. This page is the SEO-friendly companion to our full /conditions/dyspepsia/ guide.

  • Rome IV split

    Functional dyspepsia (majority) - postprandial distress syndrome and epigastric pain syndrome - versus organic causes like ulcers, GORD or gastritis.

  • Reversible driver

    Helicobacter pylori is the single most important treatable cause - test and eradicate when found.

  • First-line care

    Lifestyle change, a medication review (stop NSAIDs where possible) and a 4-8 week empirical PPI trial.

  • Red flags

    Dysphagia, weight loss, anaemia, persistent vomiting, GI bleeding or new symptoms over 55 - urgent 2-week-wait endoscopy per NICE NG184.

Why this guide matters

A stepped plan, not a shelf of antacids.

Indigestion is common, treatable and - with the right order of steps - usually controllable. The three points below shape everything else on this page.

  • Rome IV thinking helps

    Sorting people into functional dyspepsia (PDS or EPS) versus organic causes changes what tests and drugs actually help.

  • H. pylori is the big win

    Testing and eradicating H. pylori is the single most important reversible cause - do not skip the breath or stool test.

  • Endoscopy is targeted

    NICE NG184 reserves gastroscopy for red flags, failed empirical PPI or persistent symptoms - not everyone needs a camera.

How the diagnosis is made

From first burn to a clear plan.

The steps a UK GP or gastroenterologist will normally follow, in order - so you know what to expect and why.

  1. 01

    Assessing

    History and symptom pattern

    Character, timing, triggers, alarm features and the impact on eating and sleep - mapped to Rome IV PDS or EPS where relevant.

  2. 02

    Assessing

    Medication review

    NSAIDs, aspirin, steroids, bisphosphonates, iron, calcium channel blockers and SSRIs are all common offenders worth pausing or swapping.

  3. 03

    Assessing

    Examination

    Abdominal exam looking for epigastric tenderness, masses, hepatomegaly and lymphadenopathy - reassurance matters when it is normal.

  4. 04

    Confirming

    H. pylori testing

    Urea breath test or stool antigen (see /treatments/h-pylori-test/) - off PPIs for two weeks and antibiotics for four weeks for accuracy.

  5. 05

    Confirming

    Bloods and selective imaging

    FBC for anaemia, LFTs, coeliac screen and, where biliary or pancreatic disease is suspected, ultrasound or /tests/private-ct-scan/.

  6. 06

    Escalating

    Upper GI endoscopy where indicated

    Selective gastroscopy (see /treatments/gastroscopy/) for red flags, failed empirical PPI or persistent symptoms - not routine for typical dyspepsia.

  7. 07

    Escalating

    Specialist gastroenterology review

    For refractory symptoms, complex functional dyspepsia or motility questions - consider oesophageal manometry (see /treatments/oesophageal-manometry-clinic/).

Typical timeline: first visit to a settled plan in weeks, not months.

Symptoms

What indigestion actually feels like.

The classic mix of epigastric burning, fullness, bloating and belching - plus the alarm features that mean it is time to escalate.

  • Epigastric pain or burning

    A gnawing or burning sensation high in the abdomen, sometimes worse when hungry or after eating.

  • Fullness and early satiety

    Feeling uncomfortably full soon after starting a meal - a hallmark of postprandial distress syndrome.

  • Bloating in the upper abdomen

    Tight, distended upper-abdominal fullness, often with belching and no obvious wind pattern.

  • Nausea and belching

    Nausea (occasionally with vomiting) and repeated belching - common but rarely dangerous on their own.

  • Reflux-type overlap

    Many people also get heartburn and regurgitation - covered fully in our /conditions/gastro-oesophageal-reflux-disease-gord/ guide.

  • Trigger-food pattern

    Fatty meals, coffee, alcohol, spicy food and late-night eating are the most common flare-ups.

  • Waking with symptoms

    Nocturnal epigastric pain or acid brash disturbing sleep - a signal to escalate treatment.

  • Red flag - alarm features

    Dysphagia, weight loss, vomiting, anaemia, black or bloody stools or a palpable mass - urgent 2-week-wait referral per NICE NG184.

Treatment

How indigestion is treated in the UK.

Lifestyle and medication review first, an empirical PPI trial next, H. pylori eradication where positive - and specialist gastroenterology for anything that will not settle.

  • Lifestyle first

    Smaller, earlier meals, weight loss where relevant, less alcohol, stopping smoking and avoiding trigger foods (see /conditions/hiatal-hernia/).

  • Medication review

    Stop or swap NSAIDs, aspirin, bisphosphonates and other gastric irritants where safely possible - often the single biggest fix.

  • Empirical PPI trial

    Omeprazole, lansoprazole, esomeprazole, pantoprazole or rabeprazole for 4-8 weeks - the standard first pharmacological step.

  • H. pylori eradication

    Triple therapy - a PPI plus clarithromycin plus amoxicillin (or metronidazole) for 7 days - guided by local resistance and specialist input.

  • H2 receptor antagonist

    Famotidine when a PPI is unsuitable, poorly tolerated or being tapered - ranitidine has been withdrawn in the UK.

  • Antacids and alginates

    Gaviscon and simple antacids for breakthrough symptoms - safe, cheap and useful alongside longer-acting drugs.

  • Prokinetics

    Domperidone or metoclopramide, on specialist advice, for postprandial distress with delayed gastric emptying - short courses only.

  • Functional dyspepsia support

    Low-dose tricyclics or other neuromodulators, dietary work and reassurance - led by specialist gastroenterology when symptoms persist.

What this guide is based on

The sources behind every claim on this page.

UK national guidance, specialist society standards and Rome Foundation criteria - current at the time of last review.

Key references

Guidelines and standards we relied on.

A quiet reminder

This guide is for information, not medical advice.

Your GP or gastroenterologist knows your history and can tell you which parts apply to you. If in doubt, get seen.

  • NICE NG184. Gastro-oesophageal reflux disease and dyspepsia in adults: investigation and management.

  • NICE NG12. Suspected cancer: recognition and referral (upper GI 2-week-wait criteria).

  • British Society of Gastroenterology (BSG). Guidelines on the management of dyspepsia and H. pylori.

  • Rome Foundation. Rome IV criteria for functional gastroduodenal disorders.

  • MHRA. Long-term PPI safety updates - fracture, hypomagnesaemia and C. difficile risk.

  • Guts UK. Patient information on indigestion and functional dyspepsia.

Red flags

When indigestion needs urgent attention.

Most indigestion is manageable in primary care. These are the situations that are not - and where NICE NG184 wants an urgent 2-week-wait endoscopy.

  • Dysphagia

    Any new difficulty swallowing needs an urgent 2-week-wait endoscopy - see /conditions/dysphagia/ for the full workup.

  • Unintentional weight loss

    Significant unplanned weight loss with dyspepsia warrants urgent upper GI investigation.

  • Iron-deficiency anaemia

    A low ferritin with dyspepsia is an upper GI red flag until proven otherwise - refer for endoscopy.

  • Persistent vomiting

    Vomiting beyond a few days, particularly with weight loss or early satiety, needs prompt specialist assessment.

  • GI bleeding

    Haematemesis, coffee-ground vomit or melaena is a same-day emergency - attend A&E, do not wait.

  • Palpable epigastric mass

    Any new mass on examination triggers urgent 2-week-wait upper GI referral.

  • New symptoms over 55

    NICE NG184 sets a lower threshold for endoscopy in people over 55 with new or changed dyspepsia.

  • Long-term high-dose PPI

    Review annually - lowest effective dose, and weigh risks of osteoporosis, hypomagnesaemia, C. difficile and fractures.

  • Suspected biliary or pancreatic

    Right upper quadrant pain, jaundice or belt-like back pain - consider gallstones or /conditions/chronic-pancreatitis/.

Living with it

A treatable condition, with a clear ladder.

Four things that make the biggest difference day to day - meals, triggers, the right use of PPIs and knowing which symptoms mean it is time to push for endoscopy.

A quiet reminder

Consistency beats intensity, every time.

Small, steady habits - kept up for months - do more than a heroic week that does not last.

  1. 01 Meals

    Smaller, earlier, calmer

    Eat smaller portions, finish three hours before bed and slow down at the table - it does more than any supplement.

  2. 02 Triggers

    Know your own list

    Alcohol, coffee, fatty and spicy food and late-night snacking are the usual suspects - a two-week diary usually names yours.

  3. 03 Meds

    Use PPIs deliberately

    A short PPI course to settle things is fine; long-term use should be at the lowest effective dose and reviewed each year.

  4. 04 Escalate

    Don’t sit on red flags

    Dysphagia, weight loss, anaemia, vomiting or bleeding are not to be watched - ask your GP for an urgent endoscopy.

Frequently asked

Everything we get asked about indigestion.

Quick answers on Rome IV functional dyspepsia, H. pylori, PPIs and when endoscopy is needed.

  • What is indigestion?

    Indigestion, or dyspepsia, is upper-abdominal discomfort - burning, fullness, early satiety, bloating, belching or nausea centred on the epigastrium. Most cases are functional (Rome IV postprandial distress syndrome or epigastric pain syndrome); a smaller share reflects organic disease such as peptic ulcers, gastritis, GORD or, rarely, malignancy. For the full clinical picture see our /conditions/dyspepsia/ guide.

  • How is indigestion different from GORD?

    GORD is defined by acid or non-acid reflux causing heartburn and regurgitation - see /conditions/gastro-oesophageal-reflux-disease-gord/. Indigestion is a wider term for upper-abdominal symptoms and includes people whose main problem is fullness, early satiety or epigastric pain without prominent reflux. The two overlap and are often managed together.

  • When should I worry about indigestion?

    Any dysphagia, unintentional weight loss, iron-deficiency anaemia, persistent vomiting, GI bleeding (haematemesis, coffee-ground vomit or melaena), a palpable epigastric mass, or new dyspepsia over 55 should trigger an urgent 2-week-wait endoscopy per NICE NG184. Same-day bleeding needs A&E, not a GP appointment.

  • Do I need an endoscopy?

    Not always. NICE NG184 supports empirical PPI treatment and H. pylori test-and-treat in uncomplicated dyspepsia. Gastroscopy (see /treatments/gastroscopy/) is reserved for red flags, failed empirical therapy, persistent symptoms or where malignancy, ulceration or Barrett’s needs to be excluded.

  • How is H. pylori tested and treated?

    A urea breath test or stool antigen (see /treatments/h-pylori-test/) is the standard non-invasive test - stopping PPIs two weeks and antibiotics four weeks beforehand. Treatment is triple therapy: a PPI with clarithromycin plus amoxicillin (or metronidazole) for seven days, followed by a test of cure. It is the single most important reversible cause of dyspepsia.

  • Are long-term PPIs safe?

    For most people, yes - but they are not risk-free. Long-term use is associated with hypomagnesaemia, B12 deficiency, fracture risk, C. difficile infection and, in some studies, kidney and dementia signals. UK practice is the lowest effective dose, annual review and step-down where possible, with prompt endoscopy if new symptoms appear.

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