Indigestion

What is it?

Indigestion or heartburn symptoms are typically caused by the movement of stomach contents up to the esophagus. This process is called reflux. It happens to most people several times daily without causing any symptoms or problems. At times reflux can cause symptoms such as burning discomfort or pain in the stomach or chest, a sour, bitter, or salty taste in the mouth, sense of abdominal fullness, or even nausea. These symptoms are often worse at night. When symptoms are persistent it is called gastroesophageal reflux disease (GERD). Worsening symptoms can include difficulty or pain with swallowing.

What should I avoid?

Substances that cause the esophagus to relax:

  • Foods: Fats, chocolate, onions, coffee, and sugars
  • Medications: certain blood pressure medications, progesterone (found in birth control pills), theophylline (an infrequently used asthma medication)
  • Alcohol and cigarettes

Substances that irritate the stomach and esophagus:

  • Foods: citrus, tomato, coffee, and spicy foods
  • Medications: any medication in tablet form, NSAID’s (ibuprofen, naproxen), Aspirin, tetracycline (an antibiotic), and potassium chloride.

Increased pressure in the abdomen:

  • Bending, lifting, straining, exercise, and lying flat at night.
  • Eating less than 2 hours before bedtime.
  • Wearing tight fitting clothing.

What lifestyle changes might help?

  • Do not eat within 2 hours of bedtime.
  • Avoid food, medication and other substances that may worsen symptoms.
  • Maintain a healthy body weight.
  • Learn to manage stress in healthy ways.

What medications are available?

Antacids can be purchased over the counter in liquid and chewable forms. They are best used for occasional mild to moderate symptoms. Antacids are quick acting and typically last less than 6 hours. Side effects include diarrhea produced by magnesium containing products (milk of magnesia) and constipation produced by aluminum (Alternagel or Amphojel) or calcium containing products (TUMS). Products containing both aluminum and magnesium (Maalox TC or Mylanta II) are less likely to cause these side effects.

Other acid blockers are also available over the counter and best used for occasional moderate symptoms and for a short period of time. These medications include Tagamet HB, Zantac HC, Pepcid AC, and Axid AR. They can be taken twice daily and are also available in prescription strength. These medications should not be taken daily or long term except under the direction of your health care provider.

Ulcer medications called proton pump inhibitors (PPI’s) are first line treatment for GERD. They have been available by prescription only until recently when Prilosec OTC (omeprazole) was released. PPI’s symptom relief and have been shown to heal stomach ulcers and protect the esophagus from damage. They are typically taken once daily and also available in prescription strength. Some people will need higher or more frequent dosing.

When should I see my health care provider?

  • If you are having symptoms more than 1-2 times a week.
  • If your symptoms are persistent – lasting more than a couple of weeks.
  • If your symptoms come back after stopping a heartburn medication.
  • If your symptoms are severe – not relieved by antacids.
  • If you have difficulty swallowing or pain with swallowing.
  • If you have a chronic health problem and are unsure if an antacid or other OTC medication is okay for you to take.
  • If you have nausea and vomiting lasting longer than 24 hours or if you have vomited any blood.
  • If you have diarrhea lasting longer than 48 hours.
  • If you have noticed changes in your stool especially black or tarry stool or any blood in your stool.