Indigestion (dyspepsia): symptoms, causes, treatment and when to see a GP

Indigestion can be felt in different ways. The NHS lists the following symptoms after eating or drinking: heartburn (a painful burning feeling in the chest, often after eating), feeling full and bloated, feeling sick, burping and farting, and bringing up food or bitter-tasting fluids into your mouth.

Guts UK says most people have their own pattern, ranging from mild discomfort in the upper abdomen to severe pain, sometimes with pain just below the lower end of the breastbone, or a general fullness and bloating after a meal. It says symptoms should not be mixed up with heartburn, which is a burning sensation or pain behind the breastbone linked to reflux. It may also include retching or, in rare cases, vomiting.

The NHS says stomach ache or back pain are usually not symptoms of indigestion, and that if you have those you might be constipated.

Indigestion, or dyspepsia, means pain or discomfort in the upper abdomen or lower chest that typically happens after you eat or drink, according to Guts UK. It describes a group of symptoms rather than a single disease, and Guts UK says it is so common that nearly everyone will experience it at some point, but it is rare for it to be due to a serious condition.

NICE Clinical Knowledge Summaries describes dyspepsia as a complex of upper digestive symptoms typically present for four or more weeks, including upper abdominal pain or discomfort, heartburn, acid reflux, nausea and vomiting.

The NHS says indigestion is often caused by acid from the stomach irritating the stomach lining or throat, which is acid reflux. Guts UK adds that almost everyone gets indigestion now and then, often after a heavy, spicy or fatty meal, or if you rush your food, overeat or overdrink.

Guts UK says functional dyspepsia is the most common cause, diagnosed when no structural cause is found, and that eight out of ten people with indigestion have it. It happens when the stomach nerves get too sensitive, and stress, anxiety and depression can be contributing factors. Ulcers are the second most common cause, with about 8 in 100 people with indigestion having one.

Neither the NHS nor Guts UK gives a set duration, because indigestion varies from a one-off bout after a heavy meal to a pattern that comes and goes. NHS inform says the effect of an antacid only lasts for a few hours at a time, so you may need more than one dose.

What matters is whether it settles. Guts UK says if your indigestion does not improve with lifestyle changes or over-the-counter remedies, see your doctor. The NHS says to see a GP if you keep getting indigestion. NICE CKS describes dyspepsia that has been present for four or more weeks as the group of symptoms that the clinical guidance on investigation is based on.

The NHS says there is usually no need to see a GP about indigestion, and lists things you can do at home.

• Cut down on tea, coffee, cola or alcohol.

• Raise your head and shoulders up when in bed, which can stop stomach acid coming up while you sleep.

• Lose weight if you are overweight.

• Do not eat 3 to 4 hours before going to bed.

• Do not have rich, spicy or fatty foods, and do not smoke.

• Do not take ibuprofen or aspirin unless it has been prescribed for you, as they can make indigestion worse. Speak to a pharmacist or GP if you take these medicines.

The NHS says a pharmacist can recommend medicines to ease the burning feeling or pain, including antacids, alginates and proton pump inhibitors. Some indigestion medicines are best taken after eating because their effects last longer, so check the leaflet. Guts UK says some treatments neutralise stomach acid and others reduce acid production.

Guts UK says treatment usually starts by looking for fixable causes, in the first instance a test for H. pylori infection, and that if the test is negative or treating the infection does not resolve symptoms, simple lifestyle changes are advised, with medicines for further support. Guts UK stresses not to stop prescribed medicines without speaking to your doctor first.

The NHS says pregnant women often get indigestion and that it is very common from 27 weeks onwards. It can be caused by hormonal changes and the growing baby pressing against the stomach. A pharmacist can recommend the best medicines to use when you are pregnant.

The NHS says to see a GP if you keep getting indigestion, are in severe pain, have lost a lot of weight without meaning to, have difficulty swallowing, keep being sick, have iron deficiency anaemia, feel like you have a lump in your stomach, or have bloody vomit or poo. It says these symptoms can be a sign of something more serious.

Guts UK adds that you should see a doctor first before trying over-the-counter remedies if symptoms are new and you are 55 or older, and says to seek medical advice without delay for indigestion with vomiting blood or black, tarry poo, pain that suddenly develops and is severe, a fast heartbeat or rapid breathing, or a high temperature of 38C or more.

Most people will not need an endoscopy, but Guts UK says your doctor might suggest one if you are 55 or older or your symptoms keep coming back or do not improve. NHS inform says a gastroscopy is not often needed to diagnose indigestion.

On the NHS the first step is usually a pharmacist, who can advise on medicines. A GP can arrange a stool or breath test for H. pylori and refer for gastroscopy if there are warning signs, as Guts UK describes.

Private gastroscopy and H. pylori tests are available and can shorten waits. If you have a test, tell the person arranging it which medicines you take, since acid-reducing medicines and recent antibiotics can affect results, as NHS inform notes.